Provider Demographics
NPI:1396840112
Name:KEVIN P. COCHRAN DDS LLC
Entity Type:Organization
Organization Name:KEVIN P. COCHRAN DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:P
Authorized Official - Last Name:COCHRAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:937-399-9777
Mailing Address - Street 1:253 HAMPTON PL
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45503-2613
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:45503-2613
Practice Address - Country:US
Practice Address - Phone:937-399-9777
Practice Address - Fax:937-399-9781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30020445122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2512712Medicaid