Healthcare Provider Details

I. General information

NPI: 1851380075
Provider Name (Legal Business Name): COCHRAN AND DARNELL DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 08/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

890 SUNSET DR SUITE D-1A
HOLLISTER CA
95023-5641
US

IV. Provider business mailing address

890 SUNSET DR SUITE D-1A
HOLLISTER CA
95023-5641
US

V. Phone/Fax

Practice location:
  • Phone: 831-637-4623
  • Fax: 831-637-4730
Mailing address:
  • Phone: 831-637-4623
  • Fax: 831-637-4730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number28850
License Number StateCA

VIII. Authorized Official

Name: DR. MARK W DARNELL
Title or Position: PRESIDENT
Credential: DDS
Phone: 831-637-4623