Provider Demographics
NPI:1023405552
Name:JOHN P COOLICAN DMD, INC
Entity type:Organization
Organization Name:JOHN P COOLICAN DMD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:COOLICAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:570-343-8166
Mailing Address - Street 1:803 S MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18504-2757
Mailing Address - Country:US
Mailing Address - Phone:570-343-8166
Mailing Address - Fax:855-429-2585
Practice Address - Street 1:803 S MAIN AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18504-2757
Practice Address - Country:US
Practice Address - Phone:570-343-8166
Practice Address - Fax:855-429-2485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-22
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS028134L261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental