Healthcare Provider Details

I. General information

NPI: 1427300268
Provider Name (Legal Business Name): RICK E COFER DDS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2012
Last Update Date: 10/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1502 N. BRAZOS
WHITNEY TX
76692
US

IV. Provider business mailing address

1502 N. BRAZOS
WHITNEY TX
76692
US

V. Phone/Fax

Practice location:
  • Phone: 254-694-3111
  • Fax: 254-694-6292
Mailing address:
  • Phone: 254-694-3111
  • Fax: 254-694-6292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number16764
License Number StateTX

VIII. Authorized Official

Name: RICK E COFER
Title or Position: DENTIST/OWNER
Credential: DDS
Phone: 254-694-3111