Provider Demographics
NPI:1770615858
Name:COCKRELL, CHRIS RANDOLPH (DDS)
Entity type:Individual
Prefix:DR
First Name:CHRIS
Middle Name:RANDOLPH
Last Name:COCKRELL
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 MONTGOMERY XING
Mailing Address - Street 2:
Mailing Address - City:BISCOE
Mailing Address - State:NC
Mailing Address - Zip Code:27209-9592
Mailing Address - Country:US
Mailing Address - Phone:910-428-2048
Mailing Address - Fax:910-428-2328
Practice Address - Street 1:131 MONTGOMERY XING
Practice Address - Street 2:
Practice Address - City:BISCOE
Practice Address - State:NC
Practice Address - Zip Code:27209-9592
Practice Address - Country:US
Practice Address - Phone:910-428-2048
Practice Address - Fax:910-428-2328
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADA031005122300000X
NC121031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist