Provider Demographics
NPI:1134123581
Name:COCKLIN, JAMES LEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:LEE
Last Name:COCKLIN
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 1:9337 BRANDON ST
Mailing Address - Street 2:
Mailing Address - City:MANASSAS PARK
Mailing Address - State:VA
Mailing Address - Zip Code:20111-8203
Mailing Address - Country:US
Mailing Address - Phone:703-361-3999
Mailing Address - Fax:
Practice Address - Street 1:9337 BRANDON ST
Practice Address - Street 2:
Practice Address - City:MANASSAS PARK
Practice Address - State:VA
Practice Address - Zip Code:20111-8203
Practice Address - Country:US
Practice Address - Phone:703-361-3999
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1044041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice