Provider Demographics
NPI:1922476910
Name:COKER, PHILLIP LEWIS (DMD)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:LEWIS
Last Name:COKER
Suffix:
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 1:415 W PALMETTO ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-4424
Mailing Address - Country:US
Mailing Address - Phone:843-662-1596
Mailing Address - Fax:843-662-4714
Practice Address - Street 1:415 W PALMETTO ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-4424
Practice Address - Country:US
Practice Address - Phone:843-662-1596
Practice Address - Fax:843-662-4714
Is Sole Proprietor?:No
Enumeration Date:2015-09-08
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8603122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist