Provider Demographics
NPI:1962809673
Name:COOMBS, CRAIG (DDS)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:
Last Name:COOMBS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2185 N 1700 W
Mailing Address - Street 2:SUITE 203
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041
Mailing Address - Country:US
Mailing Address - Phone:801-773-5836
Mailing Address - Fax:
Practice Address - Street 1:2185 N 1700 W
Practice Address - Street 2:SUITE 203
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-1154
Practice Address - Country:US
Practice Address - Phone:801-773-5836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-24
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1381051223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1265652077OtherNPI TYPE 2
UT$$$$$$$$$016Medicaid