Provider Demographics
NPI:1568836526
Name:PETER K COCOLIS, DMD AND ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:PETER K COCOLIS, DMD AND ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:KONSTANTINE
Authorized Official - Last Name:COCOLIS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:703-912-3800
Mailing Address - Street 1:5803 ROLLING RD
Mailing Address - Street 2:SUITE 211
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22152-1047
Mailing Address - Country:US
Mailing Address - Phone:703-912-3800
Mailing Address - Fax:703-912-3816
Practice Address - Street 1:5803 ROLLING RD
Practice Address - Street 2:SUITE 211
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22152-1047
Practice Address - Country:US
Practice Address - Phone:703-912-3800
Practice Address - Fax:703-912-3816
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:POTOMAC VALLEY DENTAL CARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-11-13
Last Update Date:2015-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty