Benjamin Don Coon, DDS
Individual provider Active NPI General Practice Dentistry · Ellsworth Afb, SD
NPI 1124009956 · NPPES record last updated Feb 5, 2008
Key facts
- NPI
- 1124009956
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 1140 (WY)
- Practice address
- 2900 Doolittle Dr
Ellsworth Afb, SD 57706-4821 - Phone
- (605) 385-3500
- NPI assigned
- Nov 9, 2005
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20161020000248 | CO | Order and Referring Only - Dentist |
9638467921 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1140 | WY | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 1140 | WY | Yes |
Addresses
Primary practice location
2900 Doolittle Dr
Ellsworth Afb, SD 57706-4821
Mailing address
2900 Doolittle Dr
Ellsworth Afb, SD 57706-4821
Phone (605) 385-3657
Other providers in Ellsworth Afb, SD
- Patricia Kaydi Cassidy
- Nicholas Cattaneo
- Maxwell Tuo Cheng
- Kara Christensen
- Grace Coen
- Amy Costello
- Sable Darling
- Tara Lynn Dommert-Harrison
- Joshua R Duncan
- Kimberly C Easterling
All providers in Ellsworth Afb, SD · General Practice Dentistry in South Dakota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 5, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.