Provider Demographics
NPI:1497648166
Name:COCKE, GRANGER BAERTLETT
Entity type:Individual
Prefix:
First Name:GRANGER
Middle Name:BAERTLETT
Last Name:COCKE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:723 E 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84103-3606
Mailing Address - Country:US
Mailing Address - Phone:801-834-0176
Mailing Address - Fax:
Practice Address - Street 1:2928 NW CACHE RD
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-3827
Practice Address - Country:US
Practice Address - Phone:580-355-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-02
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK8084122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist