Provider Demographics
NPI:1356347108
Name:COCHRAN, DEVIN SCOTT (DDS)
Entity type:Individual
Prefix:DR
First Name:DEVIN
Middle Name:SCOTT
Last Name:COCHRAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14855 BLANCO ROAD
Mailing Address - Street 2:SUITE #109
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-7728
Mailing Address - Country:US
Mailing Address - Phone:210-714-5525
Mailing Address - Fax:210-981-1501
Practice Address - Street 1:14855 BLANCO ROAD
Practice Address - Street 2:SUITE #109
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-7728
Practice Address - Country:US
Practice Address - Phone:210-714-5525
Practice Address - Fax:210-981-1501
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX144781223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX090636402Medicaid
TXTPI#0906364-02Medicaid