Cockerham, John Stephen
Cockerham, John Stephen is an individual health care provider with primary practice located at 1421 S 28Th Ave , Hattiesburg MS 39402-3108. He recently has only one registered license in Dental Providers / Oral and Maxillofacial Surgery, which is considered as his primary health care specialty. Cockerham, John Stephen can be contacted via phone (601) 264-7611.Contact Information
Primary practice address
1421 S 28Th Ave
Hattiesburg MS 39402-3108
Phone: (601) 264-7611
Fax: (601) 268-0693
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / Oral and Maxillofacial Surgery | 1223S0112X | OS 20-77 | Mississippi |
Profile Details
| NPI number | 1689762528 |
|---|---|
| LBN Legal business name | Cockerham, John Stephen |
| Credentials | Doctor of Dental Surgery (DDS) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Oct 10th, 2006 |
| Last updated | Jul 8th, 2007 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1689762528 | NPPES |
| Mississippi | Other | 1602-74 | DENTAL LICENSE |
| Mississippi | MEDICAID | 0660132 | DENTAL LICENSE |
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