Provider Demographics
NPI:1588861801
Name:COCKRELL, TODD (DMD)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:
Last Name:COCKRELL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2860 MICHELLE DRIVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-1009
Mailing Address - Country:US
Mailing Address - Phone:714-508-3600
Mailing Address - Fax:714-368-2092
Practice Address - Street 1:1619 N DYSART RD
Practice Address - Street 2:SUITE 105
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-1200
Practice Address - Country:US
Practice Address - Phone:623-935-6278
Practice Address - Fax:623-935-6285
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ72701223G0001X
ORD97141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice