MEDICARE: COCODENTAL LLC

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

General Provider Information

NPI Number	:	1750080750
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COCODENTAL LLC

Provider Business Mailing Address
First Line	:	721 US HIGHWAY 1 STE 106
Second Line	:
City	:	NORTH PALM BEACH
State	:	FL
Zip	:	33408-4519
Country	:	US
Telephone Number	:	561-855-4703
Fax Number	:

Provider Business Practice Location Address
First Line	:	721 US HIGHWAY 1 STE 106
Second Line	:
City	:	NORTH PALM BEACH
State	:	FL
Zip	:	33408-4519
Country	:	US
Telephone Number	:	561-855-4703
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	DR. JOY LYNN EAKINS
Credential	:	DMD
Telephone Number	:	360-708-7790

Provider Enumeration Date	:	02/28/2023
Last Update Date	:	02/28/2023

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Directions to “COCODENTAL LLC ” Practice Location

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