Healthcare Provider Details

I. General information

NPI: 1679516553
Provider Name (Legal Business Name): MARGARET A COKER D.D.S
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1808 W BROADWAY AVE
SULPHUR OK
73086-4246
US

IV. Provider business mailing address

PO BOX 614
DAVIS OK
73030-0614
US

V. Phone/Fax

Practice location:
  • Phone: 580-622-6655
  • Fax: 580-622-6665
Mailing address:
  • Phone: 580-622-6656
  • Fax: 580-622-6665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5001
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: