Healthcare Provider Details

I. General information

NPI: 1578631875
Provider Name (Legal Business Name): RICHARD EDWARD COFER JR. DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 SAN JACINTO
WHITNEY TX
76692
US

IV. Provider business mailing address

PO BOX 1197
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:
Title or Position:
Credential:
Phone: