Provider Demographics
NPI:1447822671
Name:ROENING, COCO JEONG EN (DDS)
Entity type:Individual
Prefix:DR
First Name:COCO
Middle Name:JEONG EN
Last Name:ROENING
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 1:10411 ROSEGATE CT UNIT 306
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27617-5911
Mailing Address - Country:US
Mailing Address - Phone:415-542-6632
Mailing Address - Fax:
Practice Address - Street 1:1500 PINEY PLAINS RD
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-6898
Practice Address - Country:US
Practice Address - Phone:919-388-7777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-16
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC123851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice