Organization
BRECKINRIDGE DENTAL AND ORTHODONTICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NATHAN COUGHLIN DDS (OWNER)
(323) 898-3102
Entity
Organization
Contact information
Practice address
4150 E RENNER RD, SUITE 400, RICHARDSON, TX 75082-2816
(323) 898-3102
Mailing address
4150 E RENNER RD, #400, RICHARDSON, TX 75082-2816
(972) 248-9119
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
—
—
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
Other
Enumeration date
05/08/2015
Last updated
02/20/2017
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