Provider Demographics
NPI:1861516486
Name:COFFLER, DAYANA NOEMY (DMD)
Entity type:Individual
Prefix:DR
First Name:DAYANA
Middle Name:NOEMY
Last Name:COFFLER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1235 W VISTA WAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92083-6234
Mailing Address - Country:US
Mailing Address - Phone:760-726-7777
Mailing Address - Fax:760-732-1398
Practice Address - Street 1:1235 W VISTA WAY
Practice Address - Street 2:SUITE A
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-6234
Practice Address - Country:US
Practice Address - Phone:760-726-7777
Practice Address - Fax:760-732-1398
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACALIFORNIA 47869122300000X
OHOHIO 30021816122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist