Provider Demographics
NPI:1689969016
Name:COCKERHAM, BOBBY LEE III (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:BOBBY
Middle Name:LEE
Last Name:COCKERHAM
Suffix:III
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6719 FAIRVIEW RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-3879
Mailing Address - Country:US
Mailing Address - Phone:704-366-2774
Mailing Address - Fax:
Practice Address - Street 1:6719 FAIRVIEW RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-3879
Practice Address - Country:US
Practice Address - Phone:704-366-2774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-14
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC91241223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty