Provider Demographics
NPI:1386621894
Name:COGHILL, THOMAS MANNING (DDS)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:MANNING
Last Name:COGHILL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 W BROADWAY
Mailing Address - Street 2:
Mailing Address - City:HOPEWELL
Mailing Address - State:VA
Mailing Address - Zip Code:23860-2201
Mailing Address - Country:US
Mailing Address - Phone:804-541-8333
Mailing Address - Fax:804-541-1493
Practice Address - Street 1:2001 W BROADWAY
Practice Address - Street 2:
Practice Address - City:HOPEWELL
Practice Address - State:VA
Practice Address - Zip Code:23860-2201
Practice Address - Country:US
Practice Address - Phone:804-541-8333
Practice Address - Fax:804-541-1493
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA05062122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist