Provider Demographics
NPI:1376868505
Name:KENT COCHRAN DDS, P.C.
Entity Type:Organization
Organization Name:KENT COCHRAN DDS, P.C.
Other - Org Name:COCHRAN FAMILY DENTISTRY
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARSHALL
Authorized Official - Middle Name:KENT
Authorized Official - Last Name:COCHRAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:307-635-3044
Mailing Address - Street 1:6256 YELLOWSTONE ROAD
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-3432
Mailing Address - Country:US
Mailing Address - Phone:307-635-3044
Mailing Address - Fax:307-637-8382
Practice Address - Street 1:6256 YELLOWSTONE ROAD
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-3432
Practice Address - Country:US
Practice Address - Phone:307-635-3044
Practice Address - Fax:307-637-8382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-31
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY5671223G0001X
WY10331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty