Provider Demographics
NPI:1093092371
Name:COCKE, RICHARD NICHOLAS (DMD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:NICHOLAS
Last Name:COCKE
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:PO BOX 625
Mailing Address - Street 2:
Mailing Address - City:CALVERT CITY
Mailing Address - State:KY
Mailing Address - Zip Code:42029-0625
Mailing Address - Country:US
Mailing Address - Phone:270-395-4349
Mailing Address - Fax:270-395-0175
Practice Address - Street 1:41 INDUSTRIAL LN
Practice Address - Street 2:
Practice Address - City:CALVERT CITY
Practice Address - State:KY
Practice Address - Zip Code:42029-8418
Practice Address - Country:US
Practice Address - Phone:270-395-4349
Practice Address - Fax:270-395-0175
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-14
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY82731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice