Provider Demographics
NPI:1982918983
Name:COLBY J COCKRELL DMD PLLC
Entity type:Organization
Organization Name:COLBY J COCKRELL DMD PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:COLBY
Authorized Official - Middle Name:J
Authorized Official - Last Name:COCKRELL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:360-943-6331
Mailing Address - Street 1:PO BOX 2525
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98507-2525
Mailing Address - Country:US
Mailing Address - Phone:360-943-6331
Mailing Address - Fax:360-943-2293
Practice Address - Street 1:504 UNION AVE SE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-1429
Practice Address - Country:US
Practice Address - Phone:360-943-6331
Practice Address - Fax:360-943-2293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-02
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60023798261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental