Provider Demographics
NPI:1962500462
Name:DR. DEIDRA B KOKEL DDS PC
Entity Type:Organization
Organization Name:DR. DEIDRA B KOKEL DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEIRDRA
Authorized Official - Middle Name:B
Authorized Official - Last Name:KOKEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-777-5025
Mailing Address - Street 1:17 C FORT EVANS ROAD NE
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176
Mailing Address - Country:US
Mailing Address - Phone:703-777-5025
Mailing Address - Fax:703-777-4106
Practice Address - Street 1:17 C FORT EVANS ROAD NE
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176
Practice Address - Country:US
Practice Address - Phone:703-777-5025
Practice Address - Fax:703-777-4106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty