Organization
COCKRELL DENTAL OFFICE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEVIN M COCKRELL DDS (PARTNER)
(251) 639-0110
Entity
Organization
Contact information
Practice address
1040 HILLCREST RD, MOBILE, AL 36695
(251) 639-0110
(251) 634-1097
Mailing address
1040 HILLCREST RD, MOBILE, AL 36695
(251) 639-0110
(251) 634-1097
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4059
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
51090325
BLUE CROSS BLUE SHIELD
AL
01
—
51091274
BLUE CROSS BLUE SHIELD
AL
Enumeration date
10/31/2006
Last updated
08/22/2020
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