Provider Demographics
NPI:1215227210
Name:KOCEJA, MICHAEL KENNETH (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:KENNETH
Last Name:KOCEJA
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 1:217 SE 136TH AVE
Mailing Address - Street 2:103
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-6907
Mailing Address - Country:US
Mailing Address - Phone:360-953-8135
Mailing Address - Fax:360-953-8124
Practice Address - Street 1:217 SE 136TH AVE
Practice Address - Street 2:103
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-6907
Practice Address - Country:US
Practice Address - Phone:360-953-8135
Practice Address - Fax:360-953-8124
Is Sole Proprietor?:No
Enumeration Date:2011-04-11
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000099671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice