Healthcare Provider Details

I. General information

NPI: 1770615858
Provider Name (Legal Business Name): CHRIS RANDOLPH COCKRELL DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 MONTGOMERY XING
BISCOE NC
27209-9592
US

IV. Provider business mailing address

131 MONTGOMERY XING
BISCOE NC
27209-9592
US

V. Phone/Fax

Practice location:
  • Phone: 910-428-2048
  • Fax: 910-428-2328
Mailing address:
  • Phone: 910-428-2048
  • Fax: 910-428-2328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDA031005
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12103
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: