Organization
COGHLAN ORTHODONTICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAULA DYER (PRACTICE ADMINISTRATOR)
(812) 332-9269
Entity
Organization
Contact information
Practice address
2911 E COVENANTER DR, BLOOMINGTON, IN 47401-6320
(812) 332-9269
(812) 335-9052
Mailing address
2911 E COVENANTER DR, BLOOMINGTON, IN 47401-6320
(812) 332-9269
(812) 335-9052
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
12008895A
IN
Other
Enumeration date
03/20/2007
Last updated
08/22/2020
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