Individual
DR. OMAR T COCKEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD,MPH
Contact information
Practice address
3010 GRAND AVE, WAUKEGAN, IL 60085-2321
(847) 377-8604
Mailing address
3010 GRAND AVE, WAUKEGAN, IL 60085-2321
(847) 377-8604
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
019.029675
IL
122300000X
Dentist
Primary
DI 17684
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4608909
—
NJ
Enumeration date
03/20/2007
Last updated
12/04/2013
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