Provider Demographics
NPI:1316068455
Name:KOKICH, VINCENT (DDS, MSD)
Entity type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:
Last Name:KOKICH
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 S CEDAR ST
Mailing Address - Street 2:SUITE #E
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-2315
Mailing Address - Country:US
Mailing Address - Phone:253-627-5688
Mailing Address - Fax:253-272-6719
Practice Address - Street 1:1950 S CEDAR ST
Practice Address - Street 2:SUITE #E
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-2315
Practice Address - Country:US
Practice Address - Phone:253-627-5688
Practice Address - Fax:253-272-6719
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000084581223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics