Active NPI
Grace Coen
- Dentist
- Ellsworth Afb, SD
National Provider Identifier
1629779137
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- D11795
- Practice address
- 2900 Doolittle Dr
Ellsworth Afb, SD 57706-4821 - Phone
- (605) 385-3657
- NPI assigned
- Mar 13, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | D11795 | OR | Primary |
Addresses
Primary practice location
2900 Doolittle Dr
Ellsworth Afb, SD 57706-4821
Mailing address
804 Park Ave Apt 304
Omaha, NE 68105-2170
Phone (641) 831-0257
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
| License | State | Type | Specialty |
|---|---|---|---|
| D11795 | OR | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1678665600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1764115200000",
"number": "1629779137",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "804 PARK AVE APT 304",
"city": "OMAHA",
"state": "NE",
"postal_code": "681052170",
"telephone_number": "641-831-0257"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2900 DOOLITTLE DR",
"city": "ELLSWORTH AFB",
"state": "SD",
"postal_code": "577064821",
"telephone_number": "605-385-3657"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COEN",
"first_name": "GRACE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-03-13",
"last_updated": "2025-11-26",
"certification_date": "2025-11-26",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "OR",
"license": "D11795",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ellsworth Afb, SD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.