NPIMap

Organization Active NPI

Richard Offutt, DDS & Bobby Cockerham, DDS

Doing business as Union Periodontics & Implant Dentistry

  • Periodontics
  • Waxhaw, NC
National Provider Identifier
1609235183
Registry record updated Feb 12, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
PeriodonticsTaxonomy code 1223P0300X
License
4673 Issued in NC
Legal business name
RICHARD OFFUTT, DDS & BOBBY COCKERHAM, DDS
Doing business as
Union Periodontics & Implant Dentistry
Practice address
514 N Broome St
Waxhaw, NC 28173-7376
Phone
(704) 919-0454
NPI assigned
Feb 12, 2016
Last updated
Feb 12, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 12, 2016

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

Authorized official

Name
Richard Offutt, DDSNPI 1356391122
Title
Owner
Phone
(704) 366-2774

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PeriodonticsGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0300X 4673 NC Primary

Addresses

Primary practice location

514 N Broome St
Waxhaw, NC 28173-7376

Mailing address

6719 Fairview Rd
Charlotte, NC 28210-3879
Phone (704) 366-2774

Other names 1

  • Union Periodontics & Implant Dentistry Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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"
        }
    ]
}

Other providers in Waxhaw, NC

Sources for this page

  • 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.