# PETER K COCOLIS, DMD AND ASSOCIATES, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** POTOMAC VALLEY DENTAL CARE, LLC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1568836526
- **Legal business name:** POTOMAC VALLEY DENTAL CARE, LLC
- **Authorized official:** DR. PETER KONSTANTINE COCOLIS JR. DMD (DENTIST/OWNER)
- **Authorized official phone:** (703) 912-3800

## Contact information

- **Practice address:** 5803 ROLLING RD, SUITE 211, SPRINGFIELD, VA 22152-1047
- **Practice address phone:** (703) 912-3800
- **Practice address fax:** (703) 912-3816
- **Mailing address:** 5803 ROLLING RD, SUITE 211, SPRINGFIELD, VA 22152-1047
- **Mailing address phone:** (703) 912-3800
- **Mailing address fax:** (703) 912-3816

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 11/13/2015
- **Last updated:** 11/13/2015