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:
Map and Directions

Health care specialties

SpecialtyCodeLicense #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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1689762528 NPPES
Mississippi Other 1602-74 DENTAL LICENSE
Mississippi MEDICAID 0660132 DENTAL LICENSE

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