Provider Demographics
NPI:1528154887
Name:RICK COFER JR DDS PA
Entity type:Organization
Organization Name:RICK COFER JR DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:RICK
Authorized Official - Middle Name:E
Authorized Official - Last Name:COFER
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:254-732-0309
Mailing Address - Street 1:5400 CROSSLAKE PKWY
Mailing Address - Street 2:SUITE 400
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-6977
Mailing Address - Country:US
Mailing Address - Phone:254-732-0309
Mailing Address - Fax:254-732-0229
Practice Address - Street 1:5400 CROSSLAKE PKWY
Practice Address - Street 2:SUITE 400
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-6977
Practice Address - Country:US
Practice Address - Phone:254-732-0309
Practice Address - Fax:254-732-0229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16764122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
88D951OtherBCBS
TX292392201OtherTEXAS PROVIDER IDENTIFICATION