Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 2386 | TN |
NPI | 1063986271 |
---|---|
Provider Name | Benjamin Bruce Coffey |
First Address | Morristown, TN 37814-3863 |
Second Address | Morristown, TN 37814-3863 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2019 |
Last Update Date | 22/01/2019 |