Individual
JOHN KEVIN COGHLAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S, M.S.D.
Contact information
Practice address
2911 E COVENANTER DR, BLOOMINGTON, IN 47401-6320
(812) 332-9296
Mailing address
2911 E COVENANTER DR, BLOOMINGTON, IN 47401-6320
(812) 332-9296
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
12008895A
IN
Other
Enumeration date
07/12/2006
Last updated
07/08/2007
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