Provider Demographics
NPI:1366984395
Name:COCHRAN ORTHODONTICS PLLC
Entity type:Organization
Organization Name:COCHRAN ORTHODONTICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEVIN
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:COCHRAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:210-714-5525
Mailing Address - Street 1:14855 BLANCO RD
Mailing Address - Street 2:#109
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-7728
Mailing Address - Country:US
Mailing Address - Phone:210-714-5525
Mailing Address - Fax:210-981-1501
Practice Address - Street 1:14855 BLANCO RD
Practice Address - Street 2:#109
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-7728
Practice Address - Country:US
Practice Address - Phone:210-714-5525
Practice Address - Fax:210-981-1501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-08
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX144781223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX090636402Medicaid