| NPI | 1225582596 |
|---|---|
| Doing Business As | SOUTHPARK PERIODONTICS |
| Entity Type | Organization |
| Authorized Contact | BOBBY L COCKERHAM Owner 704-366-2774 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: NC 9124) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: NC 4673) |
| Enumeration Date | 2016-08-04 |
| Last Update Date | 2023-07-21 |