| Name: | Cockrell Dental Office, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 26 Aug 2002 (22 years ago) (Companies founded in August 2002) |
| Entity Number: | 000-684-288 |
| Register Number: | 000684288 |
| ZIP code: | 36695 (Companies in Mobile, 36695) |
| County: | Mobile |
| Place of Formation: | Mobile County |
| Principal Address: | MOBILE, AL |
| Registered Office Street Address: | 1040 HILLCREST RDMOBILE, AL 36695 |
Activities
DENTISTRY
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1285710400 | 2006-10-31 | 2020-08-22 | 1040 HILLCREST RD, MOBILE, AL, 36695, US | 1040 HILLCREST RD, MOBILE, AL, 36695, US | |||||||||||||||||||||||||||||||
|
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| Phone | +1 251-639-0110 |
| Fax | 2516341097 |
Authorized person
| Name | DR. KEVIN M COCKRELL |
| Role | PARTNER |
| Phone | 2516390110 |
Taxonomy
| Taxonomy Code | 1223G0001X - General Practice Dentistry |
| License Number | 4059 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BLUE CROSS BLUE SHIELD |
| Number | 51090325 |
| State | AL |
| Issuer | BLUE CROSS BLUE SHIELD |
| Number | 51091274 |
| State | AL |
| Name | Role |
|---|---|
| COCKRELL, KEVIN M | Member |
| COCKRELL, VANN D | Member |
| Name | Role |
|---|---|
| COCKRELL, KEVIN M | Agent |
Date of last update: 15 Aug 2024
Sources: Alabama Secretary of State
