Provider Demographics
NPI:1326240771
Name:STEPHEN M COCKEY DDS PA
Entity Type:Organization
Organization Name:STEPHEN M COCKEY DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:COCKEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:410-879-5166
Mailing Address - Street 1:754 HICKORY AVENUE
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014
Mailing Address - Country:US
Mailing Address - Phone:410-879-5166
Mailing Address - Fax:410-879-5166
Practice Address - Street 1:754 HICKORY AVENUE
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014
Practice Address - Country:US
Practice Address - Phone:410-879-5166
Practice Address - Fax:410-879-5166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD76381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty