Provider Demographics
NPI:1962592139
Name:COOMBS, JOHN A (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:A
Last Name:COOMBS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:JOHN
Other - Middle Name:A
Other - Last Name:COOMBS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS LTD
Mailing Address - Street 1:525 W WASHINGTON STREET
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89703
Mailing Address - Country:US
Mailing Address - Phone:775-882-5911
Mailing Address - Fax:775-882-0943
Practice Address - Street 1:525 W WASHINGTON STREET
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89703
Practice Address - Country:US
Practice Address - Phone:775-882-5911
Practice Address - Fax:775-882-0943
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7291223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002213720Medicaid