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General NPI Number Information
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NPI Number | 1780719484
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Entity Type | Organization
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Legal Business Name | DEIDRA B KOKEL
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Dates
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Enumeration Date | 02/22/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 17 C FORT EVANS ROAD NE
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City | LEESBURG
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State | VA
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Zip | 20176
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Country | US
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Telephone | 703-777-5025
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Fax | 703-777-4106
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Provider Business Mailing Address
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Address Line | 17 C FORT EVANS ROAD NE
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City | LEESBURG
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State | VA
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Zip | 20176
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Country | US
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Telephone | 703-777-5025
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Fax | 703-777-4106
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Authorized Official
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Title or Position | OWNER PRESIDENT
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Name | DR. DEIDRA B KOKEL
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Credential | DDS PC
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Telephone | 703-777-5025
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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