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

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

9124 Issued in NC

Practice address

6719 Fairview Rd
Charlotte, NC 28210-3879

Phone

(704) 366-2774

NPI assigned

Jun 14, 2011

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jun 20, 2016 through Jun 20, 2028

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Richard Offutt, DDS & Bobby Cockerham, DDS

  • Periodontics
  • Waxhaw, NC
  • NPI 1609235183
  NPD (past)
• R.E. Offutt, DDS, Ms and B.L. Cockerham DDS, MSP, PLLC

  • Periodontics
  • Fort Mill, SC
  • NPI 1275016263
  NPD (past)

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

{
    "created_epoch": "1308009600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1536796800000",
    "number": "1689969016",
    "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": "6719 FAIRVIEW RD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282103879",
            "telephone_number": "704-366-2774"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "514 N Broome St",
            "address_purpose": "LOCATION",
            "city": "Waxhaw",
            "state": "NC",
            "postal_code": "281737376",
            "country_code": "US",
            "telephone_number": "704-919-0454",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "929 Market St",
            "address_purpose": "LOCATION",
            "city": "Fort Mill",
            "state": "SC",
            "postal_code": "297086443",
            "country_code": "US",
            "telephone_number": "803-547-0304",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "COCKERHAM",
        "first_name": "BOBBY",
        "middle_name": "LEE",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "D.D.S, M.S.D",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-06-14",
        "last_updated": "2018-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Periodontics",
            "state": "NC",
            "license": "9124",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Andrea Weathersby Cochran, PHD
• Emma Grace Cochran, DPT
• Lucy Cochran
• Stephen G. Cochran, MD
• Yolondra Rachelle Cochran, NURSE
• Jessica Danyel Cockerham, PA
• Moriah Cockerham, LCMHCA
• Mariah Cocks
• Charles Coddington III, MD
• Brittney Coe

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.