MEDICARE: DR. SEAN K COCHRAN DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	012086	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316049232
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SEAN K COCHRAN DMD

Provider Business Mailing Address
First Line	:	3777 HIGHWAY 129 S
Second Line	:
City	:	CLEVELAND
State	:	GA
Zip	:	30528-5823
Country	:	US
Telephone Number	:	706-219-0033
Fax Number	:	706-219-0048

Provider Business Practice Location Address
First Line	:	3777 HIGHWAY 129 S
Second Line	:
City	:	CLEVELAND
State	:	GA
Zip	:	30528-5823
Country	:	US
Telephone Number	:	706-219-0033
Fax Number	:	706-219-0048

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/01/2006
Last Update Date	:	02/18/2010

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