Provider Demographics
NPI:1811535628
Name:WL COKER III DDS PLLC
Entity type:Organization
Organization Name:WL COKER III DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:LUTHER
Authorized Official - Last Name:COKER
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:804-358-1933
Mailing Address - Street 1:5500 MONUMENT AVE STE C
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-1452
Mailing Address - Country:US
Mailing Address - Phone:804-358-1933
Mailing Address - Fax:
Practice Address - Street 1:11318 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23601-2243
Practice Address - Country:US
Practice Address - Phone:757-595-2191
Practice Address - Fax:757-596-3735
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WL COKER III DDS PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-12-12
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental