Provider Demographics
NPI:1023738101
Name:COUGHRAN, ADAM CARTER (DDS)
Entity type:Individual
Prefix:DR
First Name:ADAM
Middle Name:CARTER
Last Name:COUGHRAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1821 TOULOUSE CIR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-3663
Mailing Address - Country:US
Mailing Address - Phone:318-237-5793
Mailing Address - Fax:
Practice Address - Street 1:900 S VIENNA ST
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-5830
Practice Address - Country:US
Practice Address - Phone:318-251-0334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-30
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA73081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice