Provider Demographics
NPI:1164467700
Name:OCHEV, IGOR (DDS)
Entity Type:Individual
Prefix:DR
First Name:IGOR
Middle Name:
Last Name:OCHEV
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 1:750 LAS GALLINAS AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-3438
Mailing Address - Country:US
Mailing Address - Phone:415-499-1717
Mailing Address - Fax:415-499-1713
Practice Address - Street 1:750 LAS GALLINAS AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-3438
Practice Address - Country:US
Practice Address - Phone:415-499-1717
Practice Address - Fax:415-499-1713
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA488421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice