Provider Demographics
NPI:1346350469
Name:COCHRAN, KEVIN PATRICK (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:PATRICK
Last Name:COCHRAN
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:PO BOX 1586
Mailing Address - Street 2:253 HAMPTON PL
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45501
Mailing Address - Country:US
Mailing Address - Phone:937-399-9777
Mailing Address - Fax:937-399-9781
Practice Address - Street 1:253 HAMPTON PL
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45501
Practice Address - Country:US
Practice Address - Phone:937-399-9777
Practice Address - Fax:937-399-9781
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30020445122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2014975Medicaid
OH311670421027OtherCARESOURCE
OH2512712Medicaid
OH3366OtherMOLINA