Provider Demographics
NPI:1255853388
Name:KOCHERHANS, BRETT CROFT (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRETT
Middle Name:CROFT
Last Name:KOCHERHANS
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 1:4660 W CHRYSAN CIR
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99623-9273
Mailing Address - Country:US
Mailing Address - Phone:801-581-8951
Mailing Address - Fax:
Practice Address - Street 1:1401 S SEWARD MERIDIAN PKWY STE E
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-8312
Practice Address - Country:US
Practice Address - Phone:907-357-5018
Practice Address - Fax:907-864-1091
Is Sole Proprietor?:No
Enumeration Date:2017-07-11
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1237341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice