Provider Demographics
NPI:1124409776
Name:COCHRAN, CAROLYN (DMD)
Entity Type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:
Last Name:COCHRAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 ELDER ST
Mailing Address - Street 2:
Mailing Address - City:IRONDALE
Mailing Address - State:AL
Mailing Address - Zip Code:35210-2502
Mailing Address - Country:US
Mailing Address - Phone:251-422-7680
Mailing Address - Fax:
Practice Address - Street 1:112 ELDER ST
Practice Address - Street 2:
Practice Address - City:IRONDALE
Practice Address - State:AL
Practice Address - Zip Code:35210-2502
Practice Address - Country:US
Practice Address - Phone:251-422-7680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-09
Last Update Date:2015-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL6188122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL6188Medicaid