Provider Demographics
NPI:1417394206
Name:COCKRELL, CHADD JOSEPH (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHADD
Middle Name:JOSEPH
Last Name:COCKRELL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 EVERETT ST
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-2404
Mailing Address - Country:US
Mailing Address - Phone:207-729-8939
Mailing Address - Fax:
Practice Address - Street 1:10 EVERETT ST
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-2404
Practice Address - Country:US
Practice Address - Phone:207-729-8939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDEN4570122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty