Provider Demographics
NPI:1497772842
Name:W STEPHEN COKER DMD PA
Entity Type:Organization
Organization Name:W STEPHEN COKER DMD PA
Other - Org Name:PARKWAY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:RODELY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-380-9622
Mailing Address - Street 1:3600 NW CARY PARKWAY
Mailing Address - Street 2:SUITE 115
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513
Mailing Address - Country:US
Mailing Address - Phone:919-380-9622
Mailing Address - Fax:919-380-9758
Practice Address - Street 1:3600 NW CARY PARKWAY
Practice Address - Street 2:SUITE 115
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513
Practice Address - Country:US
Practice Address - Phone:919-380-9622
Practice Address - Fax:919-380-9758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6021122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8991705Medicaid
NC=========OtherTAX ID