Provider Demographics
NPI:1083097422
Name:COCHRAN, PHILIP ELLIOT
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:ELLIOT
Last Name:COCHRAN
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 1:1103 BROWN ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27889-3766
Mailing Address - Country:US
Mailing Address - Phone:252-946-3355
Mailing Address - Fax:252-948-0578
Practice Address - Street 1:1103 BROWN ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NC
Practice Address - Zip Code:27889-3766
Practice Address - Country:US
Practice Address - Phone:252-946-3355
Practice Address - Fax:252-948-0578
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-02
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10037122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist