Healthcare Provider Details

I. General information

NPI: 1528013331
Provider Name (Legal Business Name): JOHN P COFER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HQS, U.S. ARMY DENTAL ACTIVITY 51005 WINANS RILEY BARRACKS EAST WING
FORT HUACHUCA AZ
85613-7040
US

IV. Provider business mailing address

HQS, U.S. ARMY DENTAL ACTIVITY 51005 WINANS RILEY BARRACKS EAST WING
FORT HUACHUCA AZ
85613-7040
US

V. Phone/Fax

Practice location:
  • Phone: 520-533-3144
  • Fax: 520-533-7285
Mailing address:
  • Phone: 520-533-3144
  • Fax: 520-533-7285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401006322
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: