Individual
DR. JOHN STEPHEN COCKERHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
1421 S 28TH AVE, HATTIESBURG, MS 39402-3108
(601) 264-7611
(601) 268-0693
Mailing address
1421 S 28TH AVE, HATTIESBURG, MS 39402-3108
(601) 264-7611
(601) 268-0693
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
OS 20-77
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0660132
—
MS
01
—
1602-74
DENTAL LICENSE
MS
Enumeration date
10/10/2006
Last updated
07/08/2007
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