Individual
JACK FRANCIS COBURN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
9020 W JUDGE PEREZ DR, CHALMETTE, LA 70043-4500
(504) 277-4401
Mailing address
3142 STATE STREET DR, NEW ORLEANS, LA 70125-4241
(503) 806-9210
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
7163
LA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
02/19/2020
Last updated
03/31/2023
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