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General NPI Number Information
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NPI Number | 1285710400
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Entity Type | Organization
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Legal Business Name | COCKRELL DENTAL OFFICE LLC
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Dates
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Enumeration Date | 10/31/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1040 HILLCREST RD
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City | MOBILE
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State | AL
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Zip | 36695
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Country | US
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Telephone | 251-639-0110
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Fax | 251-634-1097
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Provider Business Mailing Address
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Address Line | 1040 HILLCREST RD
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City | MOBILE
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State | AL
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Zip | 36695
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Country | US
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Telephone | 251-639-0110
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Fax | 251-634-1097
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Authorized Official
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Title or Position | PARTNER
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Name | DR. KEVIN M COCKRELL
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Credential | DDS
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Telephone | 251-639-0110
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 4059
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License Number State | AL
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