MEDICARE: DR. BRIAN DAMIAN COERVER DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	4346	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588779524
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN DAMIAN COERVER DDS

Provider Business Mailing Address
First Line	:	1401 ARLINGTON
Second Line	:
City	:	ADA
State	:	OK
Zip	:	74820-2636
Country	:	US
Telephone Number	:	580-332-4872
Fax Number	:	580-436-1971

Provider Business Practice Location Address
First Line	:	1401 ARLINGTON
Second Line	:
City	:	ADA
State	:	OK
Zip	:	74820-2636
Country	:	US
Telephone Number	:	580-332-4872
Fax Number	:	580-436-1971

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	07/12/2012

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