Healthcare Provider Details

I. General information

NPI: 1356347108
Provider Name (Legal Business Name): DEVIN SCOTT COCHRAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 01/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14855 BLANCO ROAD SUITE #109
SAN ANTONIO TX
78216-7728
US

IV. Provider business mailing address

14855 BLANCO ROAD SUITE #109
SAN ANTONIO TX
78216-7728
US

V. Phone/Fax

Practice location:
  • Phone: 210-714-5525
  • Fax: 210-981-1501
Mailing address:
  • Phone: 210-714-5525
  • Fax: 210-981-1501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number14478
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: