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NPI Code Detail

MEDICARE: DR. GARY ALLAN KOKX D.M.D.

MEDICARE: DR. GARY ALLAN KOKX D.M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry2491ME

General Provider Information

NPI Number : 1073541264
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GARY ALLAN KOKX D.M.D.
Provider Business Mailing Address
First Line : 25 LONG CREEK DR
Second Line : 1
City : SOUTH PORTLAND
State : ME
Zip : 04106-2440
Country : US
Telephone Number : 207-774-6553
Fax Number : 207-774-0496
Provider Business Practice Location Address
First Line : 25 LONG CREEK DR
Second Line : 1
City : SOUTH PORTLAND
State : ME
Zip : 04106-2440
Country : US
Telephone Number : 207-774-6553
Fax Number : 207-774-0496
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/28/2006
Last Update Date : 07/08/2007

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