Provider Demographics
NPI:1568594091
Name:ROBERT C COCHRAN DDS, LLC
Entity Type:Organization
Organization Name:ROBERT C COCHRAN DDS, LLC
Other - Org Name:MOSS BLUFF FAMILY DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:COCHRAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:337-855-7748
Mailing Address - Street 1:1434 SAM HOUSTON JONES PKWY
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70611-5458
Mailing Address - Country:US
Mailing Address - Phone:337-855-7748
Mailing Address - Fax:337-855-7996
Practice Address - Street 1:1434 SAM HOUSTON JONES PKWY
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70611-5458
Practice Address - Country:US
Practice Address - Phone:337-855-7748
Practice Address - Fax:337-855-7996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-11
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA48671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty