Provider Demographics
NPI:1568182368
Name:FOCHT, KELSEY (DMD)
Entity Type:Individual
Prefix:DR
First Name:KELSEY
Middle Name:
Last Name:FOCHT
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6634 W MONONA DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-6656
Mailing Address - Country:US
Mailing Address - Phone:509-699-0336
Mailing Address - Fax:
Practice Address - Street 1:1646 N LITCHFIELD RD STE 125
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-1273
Practice Address - Country:US
Practice Address - Phone:623-935-2755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-31
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD011473122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist