Provider Demographics
NPI:1619029188
Name:KOKANOS, JANE P (RDH)
Entity Type:Individual
Prefix:MRS
First Name:JANE
Middle Name:P
Last Name:KOKANOS
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:423 DONNELL RD
Mailing Address - Street 2:
Mailing Address - City:LOWER BURRELL
Mailing Address - State:PA
Mailing Address - Zip Code:15068-3411
Mailing Address - Country:US
Mailing Address - Phone:724-339-4890
Mailing Address - Fax:
Practice Address - Street 1:102 NORTH PIKE RD.
Practice Address - Street 2:
Practice Address - City:SARVER
Practice Address - State:PA
Practice Address - Zip Code:16055
Practice Address - Country:US
Practice Address - Phone:724-353-1521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADH003979L124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist