Provider Demographics
NPI:1235245424
Name:COCKLEY, LORENA DIANE (DDS)
Entity Type:Individual
Prefix:DR
First Name:LORENA
Middle Name:DIANE
Last Name:COCKLEY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 W KING ST
Mailing Address - Street 2:
Mailing Address - City:EAST BERLIN
Mailing Address - State:PA
Mailing Address - Zip Code:17316-9667
Mailing Address - Country:US
Mailing Address - Phone:717-259-9596
Mailing Address - Fax:717-259-0703
Practice Address - Street 1:418 W KING ST
Practice Address - Street 2:
Practice Address - City:EAST BERLIN
Practice Address - State:PA
Practice Address - Zip Code:17316-9667
Practice Address - Country:US
Practice Address - Phone:717-259-9596
Practice Address - Fax:717-259-0703
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS 031424L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice