Individual
DR. JACOB EDWARD COFFEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D
Contact information
Practice address
1491 E 10TH ST, ROLLA, MO 65401-3996
(573) 364-2868
Mailing address
690 DONALD DR, ROLLA, MO 65401-4803
(217) 827-8033
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2016029131
MO
Other
Enumeration date
08/12/2016
Last updated
08/12/2016
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