Individual provider Active NPI

Grace Elizabeth Beck Coburn, DMD

  • Endodontics
  • Eugene, OR
National Provider Identifier
1104455401
Registry record updated Oct 23, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
EndodonticsTaxonomy code 1223E0200X
License
D12286 Issued in OR
Practice address
2233 Willamette St
Eugene, OR 97405-3095
Phone
(831) 566-5107
NPI assigned
Apr 7, 2020
Last updated
Oct 23, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Endodontics 1223E0200X D12286 OR Primary

Addresses

Primary practice location

2233 Willamette St
Eugene, OR 97405-3095

Mailing address

2233 Willamette St
Eugene, OR 97405-3095
Phone (831) 566-5107

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
7049LAMDEndodontist

Practice roles

OrganizationSpecialtyStatusNew patients
Garrett B Morris DDS LLC Endodontics CurrentSince Jun 1, 2020 Accepting new patients
Tanika Hale DDS LLC PastSince Aug 18, 2024 Accepting new patients

Locations

3100 Galleria Dr
Ste 206
Metairie, LA 70001
Phone (504) 885-0177

4520 Clearview Pkwy
Metairie, LA 70006
Phone (504) 885-0177

1011 Highway 90
Bay St Louis, MS 39520
Phone (228) 466-6676

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1586217600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1792713600000",
    "number": "1104455401",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2233 WILLAMETTE ST",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974053095",
            "telephone_number": "831-566-5107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2233 WILLAMETTE ST",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974053095",
            "telephone_number": "831-566-5107"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COBURN",
        "first_name": "GRACE",
        "middle_name": "ELIZABETH BECK",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-04-07",
        "last_updated": "2026-10-23",
        "certification_date": "2026-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "OR",
            "license": "D12286",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Eugene, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.