Provider Demographics
NPI:1114021664
Name:COCHRAN, BRADLEY STEWART (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:STEWART
Last Name:COCHRAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 W 2ND ST
Mailing Address - Street 2:P.O. BOX 1546
Mailing Address - City:DENVER CITY
Mailing Address - State:TX
Mailing Address - Zip Code:79323-3101
Mailing Address - Country:US
Mailing Address - Phone:806-592-3468
Mailing Address - Fax:806-592-7566
Practice Address - Street 1:117 W 2ND ST
Practice Address - Street 2:
Practice Address - City:DENVER CITY
Practice Address - State:TX
Practice Address - Zip Code:79323-3101
Practice Address - Country:US
Practice Address - Phone:806-592-3468
Practice Address - Fax:806-592-7566
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX159011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice