Provider Demographics
NPI:1477702843
Name:COCKRELL, COLBY (DMD)
Entity Type:Individual
Prefix:DR
First Name:COLBY
Middle Name:
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 1:1505 S GLENBURNIE RD
Mailing Address - Street 2:UNIT IJ
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-2625
Mailing Address - Country:US
Mailing Address - Phone:252-672-4404
Mailing Address - Fax:
Practice Address - Street 1:1505 S GLENBURNIE RD
Practice Address - Street 2:UNIT IJ
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-2625
Practice Address - Country:US
Practice Address - Phone:252-672-4404
Practice Address - Fax:252-672-4402
Is Sole Proprietor?:No
Enumeration Date:2008-09-10
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8691122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist