Provider Demographics
NPI:1134668734
Name:ROCHFORD, BRIAN (DDS, MSD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:ROCHFORD
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8445 S EMERSON AVE
Mailing Address - Street 2:#102
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-9596
Mailing Address - Country:US
Mailing Address - Phone:317-888-2827
Mailing Address - Fax:
Practice Address - Street 1:8445 S EMERSON AVE
Practice Address - Street 2:#102
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-9596
Practice Address - Country:US
Practice Address - Phone:317-888-2827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-15
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12012198A1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics