Provider Demographics
NPI:1558467498
Name:BARRY P SETZER DDS AND STEPHEN D COCHRAN DMD PA
Entity Type:Organization
Organization Name:BARRY P SETZER DDS AND STEPHEN D COCHRAN DMD PA
Other - Org Name:PEDIATRIC DENTISTRY
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER CO
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:P
Authorized Official - Last Name:SETZER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:904-733-7254
Mailing Address - Street 1:8355 BAYBERRY ROAD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256
Mailing Address - Country:US
Mailing Address - Phone:904-733-7254
Mailing Address - Fax:904-731-0144
Practice Address - Street 1:8355 BAYBERRY ROAD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256
Practice Address - Country:US
Practice Address - Phone:904-733-7254
Practice Address - Fax:904-731-0144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN61381223P0221X
FLDN126671223P0221X
FLDN136821223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL74810OtherBCBS
GA00419295AMedicaid
FL0763373OtherMEDICAID