Provider Demographics
NPI:1639270911
Name:COKER, JOHN HERBERT JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:HERBERT
Last Name:COKER
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10472 GEORGETOWN DRIVE
Mailing Address - Street 2:
Mailing Address - City:SPOTSYLVANIA
Mailing Address - State:VA
Mailing Address - Zip Code:22553
Mailing Address - Country:US
Mailing Address - Phone:540-898-2200
Mailing Address - Fax:540-898-1505
Practice Address - Street 1:10472 GEORGETOWN DRIVE
Practice Address - Street 2:
Practice Address - City:SPOTSYLVANIA
Practice Address - State:VA
Practice Address - Zip Code:22553
Practice Address - Country:US
Practice Address - Phone:540-898-2200
Practice Address - Fax:540-898-1505
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04000592122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9178523Medicaid