Provider Demographics
NPI:1578630042
Name:BOCKIAN & COWAN D.D.S. P.A,
Entity Type:Organization
Organization Name:BOCKIAN & COWAN D.D.S. P.A,
Other - Org Name:DENTAL CENTER OF SILVER LAKES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOCKIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:954-704-0044
Mailing Address - Street 1:1550 BREAKWATER TER
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33019-5023
Mailing Address - Country:US
Mailing Address - Phone:954-704-0044
Mailing Address - Fax:954-704-8302
Practice Address - Street 1:17027 PINES BLVD
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33027-1003
Practice Address - Country:US
Practice Address - Phone:954-704-0044
Practice Address - Fax:954-704-8302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN62961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty