Provider Demographics
NPI:1003299355
Name:COCHRANE, GREGORY (DDS)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:
Last Name:COCHRANE
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 1:3143 STATE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-6964
Mailing Address - Country:US
Mailing Address - Phone:608-788-0030
Mailing Address - Fax:
Practice Address - Street 1:3143 STATE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-6964
Practice Address - Country:US
Practice Address - Phone:608-788-0030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-06
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10011631223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice