Provider Demographics
NPI:1962716472
Name:COGGINS, CHERYL R (DDS)
Entity type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:R
Last Name:COGGINS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 SHADY HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-7840
Mailing Address - Country:US
Mailing Address - Phone:615-243-3581
Mailing Address - Fax:
Practice Address - Street 1:440 SAM RIDLEY PKWY W STE 140
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-2999
Practice Address - Country:US
Practice Address - Phone:615-625-2910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-27
Last Update Date:2017-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5154122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5154OtherTENNESSEE STATE LICENSE
TN1520633Medicaid