Provider Demographics
NPI:1730538661
Name:KOKER, GIANNA PAOLA (SURGEON DENTIST)
Entity type:Individual
Prefix:
First Name:GIANNA
Middle Name:PAOLA
Last Name:KOKER
Suffix:
Gender:F
Credentials:SURGEON DENTIST
Other - Prefix:
Other - First Name:GIANNA
Other - Middle Name:PAOLA
Other - Last Name:KOKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:973 SKYLINE DR SW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55902-1220
Mailing Address - Country:US
Mailing Address - Phone:208-996-5851
Mailing Address - Fax:507-424-1042
Practice Address - Street 1:4310 MENARD DR STE 300
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55811-1564
Practice Address - Country:US
Practice Address - Phone:218-279-9985
Practice Address - Fax:218-279-9987
Is Sole Proprietor?:No
Enumeration Date:2016-06-10
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLGL14122300000X
MN14279122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist