Provider Demographics
NPI:1992145221
Name:COCONU, MARIANA NICOLETA (DDS)
Entity type:Individual
Prefix:
First Name:MARIANA
Middle Name:NICOLETA
Last Name:COCONU
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 1:1808 SW 24TH ST
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73170-7476
Mailing Address - Country:US
Mailing Address - Phone:405-921-7598
Mailing Address - Fax:
Practice Address - Street 1:305 NORTHRIDGE CIR
Practice Address - Street 2:
Practice Address - City:GUYMON
Practice Address - State:OK
Practice Address - Zip Code:73942-2735
Practice Address - Country:US
Practice Address - Phone:405-921-7598
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-01
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK64741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice