Provider Demographics
NPI:1497964175
Name:KOCHENDERFER, NANCY LEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:LEE
Last Name:KOCHENDERFER
Suffix:
Gender:F
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:HHC 22ND SIG BDE
Mailing Address - Street 2:CMR 431 BOX 519
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09175
Mailing Address - Country:US
Mailing Address - Phone:6151-951-8369
Mailing Address - Fax:
Practice Address - Street 1:10906 S SHORE DR
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55441-4919
Practice Address - Country:US
Practice Address - Phone:763-545-1837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND108681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice