Provider Demographics
NPI:1568501229
Name:DR. R. BRUCE COCHRANE DDS, PC
Entity Type:Organization
Organization Name:DR. R. BRUCE COCHRANE DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:HOOVER
Authorized Official - Suffix:
Authorized Official - Credentials:RDA
Authorized Official - Phone:515-576-8151
Mailing Address - Street 1:1611 1ST AVE N
Mailing Address - Street 2:
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-4253
Mailing Address - Country:US
Mailing Address - Phone:515-576-8151
Mailing Address - Fax:515-576-5670
Practice Address - Street 1:318 S MAPLE ST
Practice Address - Street 2:
Practice Address - City:CARROLL
Practice Address - State:IA
Practice Address - Zip Code:51401-3100
Practice Address - Country:US
Practice Address - Phone:712-792-6313
Practice Address - Fax:712-792-6314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA62511223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2143495Medicaid
IA14349Medicare ID - Type Unspecified