Provider Demographics
NPI:1073969473
Name:COFER, ANTONIA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANTONIA
Middle Name:
Last Name:COFER
Suffix:
Gender:F
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:PO BOX 9862
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20016-8862
Mailing Address - Country:US
Mailing Address - Phone:202-588-8500
Mailing Address - Fax:202-722-0400
Practice Address - Street 1:5437 CONN AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20015-2770
Practice Address - Country:US
Practice Address - Phone:202-588-8500
Practice Address - Fax:202-722-0400
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-04
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN5323122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice