=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528021672
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHRISTINE JEANETTE COKE DDS,MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/10/2006
-----------------------------------------------------
Last Update Date | 11/01/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 107 SUNCREEK DR SUITE 200
-----------------------------------------------------
City | ALLEN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75013-2833
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-383-1380
-----------------------------------------------------
Fax | 214-383-1379
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 107 SUNCREEK DR SUITE 200
-----------------------------------------------------
City | ALLEN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75013-2833
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-383-1380
-----------------------------------------------------
Fax | 214-383-1379
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223S0112X
-----------------------------------------------------
Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
-----------------------------------------------------
License Number | 18782
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------