1275016263 NPI number — R.E. OFFUTT, DDS, MS AND B.L. COCKERHAM DDS, MSP, PLLC

Table of content: (NPI 1275016263)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275016263 NPI number — R.E. OFFUTT, DDS, MS AND B.L. COCKERHAM DDS, MSP, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
R.E. OFFUTT, DDS, MS AND B.L. COCKERHAM DDS, MSP, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275016263
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/18/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6719 FAIRVIEW ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28210
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-366-2774
Provider Business Mailing Address Fax Number:
704-366-2639

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
929 MARKET ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT MILL
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29708
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-547-0304
Provider Business Practice Location Address Fax Number:
704-366-2639
Provider Enumeration Date:
09/14/2018

Additional Information

Authorized Official

Authorized Official Last Name:
OFFUTT
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
704-366-2774

Provider Taxonomy Codes

  • Taxonomy code: 1223P0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com