1568836526 NPI number — PETER K COCOLIS, DMD AND ASSOCIATES, PLLC

Table of content: (NPI 1568836526)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568836526 NPI number — PETER K COCOLIS, DMD AND ASSOCIATES, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PETER K COCOLIS, DMD AND ASSOCIATES, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568836526
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/13/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5803 ROLLING RD
Provider Second Line Business Mailing Address:
SUITE 211
Provider Business Mailing Address City Name:
SPRINGFIELD
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22152-1047
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-912-3800
Provider Business Mailing Address Fax Number:
703-912-3816

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5803 ROLLING RD
Provider Second Line Business Practice Location Address:
SUITE 211
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22152-1047
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-912-3800
Provider Business Practice Location Address Fax Number:
703-912-3816
Provider Enumeration Date:
11/13/2015

Additional Information

Authorized Official

Authorized Official Last Name:
COCOLIS
Authorized Official First Name:
PETER
Authorized Official Middle Name:
KONSTANTINE
Authorized Official Title or Position:
DENTIST/OWNER
Authorized Official Telephone Number:
703-912-3800

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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