Provider Demographics
NPI:1801985106
Name:COCOLIS, PETER K JR (DMD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:K
Last Name:COCOLIS
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:5803 ROLLING RD
Mailing Address - Street 2:SUITE 211
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22152-1047
Mailing Address - Country:US
Mailing Address - Phone:703-912-3800
Mailing Address - Fax:703-912-3816
Practice Address - Street 1:5803 ROLLING RD
Practice Address - Street 2:SUITE 211
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22152-1047
Practice Address - Country:US
Practice Address - Phone:703-912-3800
Practice Address - Fax:703-912-3816
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA04010082741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice