Healthcare Provider Details

I. General information

NPI: 1811980170
Provider Name (Legal Business Name): CRAIG S COCHRAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 SE HOWARD AVE
BARTLESVILLE OK
74006-2204
US

IV. Provider business mailing address

215 SE HOWARD AVE
BARTLESVILLE OK
74006-2204
US

V. Phone/Fax

Practice location:
  • Phone: 918-333-9155
  • Fax: 918-333-9142
Mailing address:
  • Phone: 918-333-9155
  • Fax: 918-333-9142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number4751
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: