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General NPI Number Information
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NPI Number | 1982918983
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Entity Type | Organization
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Legal Business Name | COLBY J COCKRELL DMD PLLC
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Dates
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Enumeration Date | 08/02/2010
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Last Update Date | 08/02/2010
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Provider Practice Location Address
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Address Line | 504 UNION AVE SE
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City | OLYMPIA
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State | WA
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Zip | 98501-1429
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Country | US
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Telephone | 360-943-6331
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Fax | 360-943-2293
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Provider Business Mailing Address
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Address Line | PO BOX 2525
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City | OLYMPIA
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State | WA
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Zip | 98507-2525
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Country | US
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Telephone | 360-943-6331
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Fax | 360-943-2293
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Authorized Official
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Title or Position | OWNER
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Name | DR. COLBY J COCKRELL
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Credential | DMD
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Telephone | 360-943-6331
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | DE60023798
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License Number State | WA
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