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NPI Code Detail

MEDICARE: DR. TODD COCKRELL DMD

MEDICARE: DR. TODD COCKRELL 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
11223G0001XGeneral Practice Dentistry7270AZ
21223G0001XGeneral Practice DentistryD9714OR

General Provider Information

NPI Number : 1588861801
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TODD COCKRELL DMD
Provider Business Mailing Address
First Line : 2860 MICHELLE DRIVE
Second Line : 2ND FLOOR
City : IRVINE
State : CA
Zip : 92606-1009
Country : US
Telephone Number : 714-508-3600
Fax Number : 714-368-2092
Provider Business Practice Location Address
First Line : 1619 N DYSART RD
Second Line : SUITE 105
City : AVONDALE
State : AZ
Zip : 85392-1200
Country : US
Telephone Number : 623-935-6278
Fax Number : 623-935-6285
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/29/2007
Last Update Date : 05/14/2012

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Directions to “ DR. TODD COCKRELL DMD” Practice Location

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