B.L. COCKERHAM III & ASSOCIATES PLLC NPI 1225582596

NPI Information

  • NPI: 1225582596
  • Provider Name: B.L. COCKERHAM III & ASSOCIATES PLLC
  • Classification: Dentist - 1223P0300X
  • Specialization: Periodontics
  • Entity Type: Organization
  • Doing Business As: SOUTHPARK PERIODONTICS
  • CLIA Number: 34D1005728
  • Address: 6719 FAIRVIEW RD
    CHARLOTTE, NC
    ZIP 28210
  • Phone: (704) 366-2774

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NPI Details

B.L. COCKERHAM III & ASSOCIATES PLLC is a periodontics dentist in Charlotte, NC. The provider is that specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues. B.L. COCKERHAM III & ASSOCIATES PLLC NPI is 1225582596. The provider is registered as an organization entity type and is a multiple single specialty group.
The provider Is Doing Business As Southpark Periodontics.

The provider's business location address is:

6719 FAIRVIEW RD
CHARLOTTE, NC
ZIP 28210-879
Phone: (704) 366-2774
Fax: (704) 366-2639

The provider's authorized official is Bobby L Cockerham .
The authorized official title is Owner and has the following contact phone number (704) 366-2774.

The CLIA number assigned to this NPI record is 34D1005728 - ambulatory surgery center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/4/2016 and was last updated on 7/21/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
11223P0300XDentistPeriodontics4673NORTH CAROLINANo
21223P0300XDentistPeriodontics9124NORTH CAROLINAYes

What is NPI?

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This page was last updated on: 11/21/2025

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