Richard Offutt, DDS & Bobby Cockerham, DDS

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

4673 Issued in NC

Legal business name

RICHARD OFFUTT, DDS & BOBBY COCKERHAM, DDS

Practice address

514 N Broome St
Waxhaw, NC 28173-7376

Phone

(704) 919-0454

NPI assigned

Feb 12, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Richard Offutt, DDS

Title

Owner

Phone

(704) 366-2774

Specialties & licenses 1

Addresses

Other names 1

• Union Periodontics & Implant Dentistry Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Bobby Lee Cockerham III, D.D.S, M.S.D

  • Periodontics
  • Charlotte, NC
  • NPI 1689969016
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1455235200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1455235200000",
    "number": "1609235183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6719 FAIRVIEW RD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282103879",
            "telephone_number": "704-366-2774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "514 N BROOME ST",
            "city": "WAXHAW",
            "state": "NC",
            "postal_code": "281737376",
            "telephone_number": "704-919-0454"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RICHARD OFFUTT, DDS & BOBBY COCKERHAM, DDS",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-12",
        "last_updated": "2016-02-12",
        "status": "A",
        "authorized_official_last_name": "OFFUTT",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "704-366-2774",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Periodontics",
            "state": "NC",
            "license": "4673",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Union Periodontics & Implant Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Tasha Regan
• Madison Joann Reis
• Jenny Renville, DHA, MA, LCMHCA, NCC
• Resolute Care Services Inc
• Kelly Elizabeth Reyer, OTD, OTR/L
• Jordan R Richards
• Troy Riley, PHARM.D
• Sydnea Ann-Clark Rinehart, PHARMD
• Brittany Rivera
• Sabrina Robinson

• Periodontics in Waxhaw, NC
• Providers in Waxhaw, NC by specialty
• Periodontics in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.