MEDICARE: DR. JAMES LEE COCKLIN DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	104404	CO

General Provider Information

NPI Number	:	1134123581
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES LEE COCKLIN DDS

Provider Business Mailing Address
First Line	:	9337 BRANDON ST
Second Line	:
City	:	MANASSAS PARK
State	:	VA
Zip	:	20111-8203
Country	:	US
Telephone Number	:	703-361-3999
Fax Number	:

Provider Business Practice Location Address
First Line	:	9337 BRANDON ST
Second Line	:
City	:	MANASSAS PARK
State	:	VA
Zip	:	20111-8203
Country	:	US
Telephone Number	:	703-361-3999
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	07/08/2007

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