Provider Demographics
NPI:1740853274
Name:COCKERELL, NICHOLAS NANCE (DDS)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:NANCE
Last Name:COCKERELL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4330 MCKNIGHT RD
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-0923
Mailing Address - Country:US
Mailing Address - Phone:903-838-9700
Mailing Address - Fax:903-832-3505
Practice Address - Street 1:4330 MCKNIGHT RD
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-0923
Practice Address - Country:US
Practice Address - Phone:903-838-9700
Practice Address - Fax:903-832-3505
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-22
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37605122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist