Provider Demographics
NPI:1003074782
Name:BRIAN D. COERVER, DDS
Entity Type:Organization
Organization Name:BRIAN D. COERVER, DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:DAMIAN
Authorized Official - Last Name:COERVER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:580-332-4872
Mailing Address - Street 1:1401 ARLINGTON ST
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-2636
Mailing Address - Country:US
Mailing Address - Phone:580-332-4872
Mailing Address - Fax:580-436-1971
Practice Address - Street 1:1401 ARLINGTON ST
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-2636
Practice Address - Country:US
Practice Address - Phone:580-332-4872
Practice Address - Fax:580-436-1971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4346261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental