Provider Demographics
NPI:1922307032
Name:COVINGTON, KOKO (DDS)
Entity Type:Individual
Prefix:
First Name:KOKO
Middle Name:
Last Name:COVINGTON
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 1:110 VILLA RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-3010
Mailing Address - Country:US
Mailing Address - Phone:864-419-4516
Mailing Address - Fax:
Practice Address - Street 1:216 SCUFFLETOWN RD STE D
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29681-7202
Practice Address - Country:US
Practice Address - Phone:785-564-0929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-16
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7148122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist