Provider Demographics
NPI:1811206675
Name:COCKLEY'S PLAYTIME DENTAL
Entity Type:Organization
Organization Name:COCKLEY'S PLAYTIME DENTAL
Other - Org Name:PLAYTIME DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JACKSON
Authorized Official - Middle Name:
Authorized Official - Last Name:COCKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:419-774-7529
Mailing Address - Street 1:1145 ASPIRA CT
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44906-4125
Mailing Address - Country:US
Mailing Address - Phone:419-774-7529
Mailing Address - Fax:419-774-7529
Practice Address - Street 1:1145 ASPIRA CT
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44906-4125
Practice Address - Country:US
Practice Address - Phone:419-774-7529
Practice Address - Fax:419-774-7529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-28
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300219451223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty