Provider Demographics
NPI:1578922159
Name:MARK L. KOCHEVAR DMD
Entity Type:Organization
Organization Name:MARK L. KOCHEVAR DMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLEE
Authorized Official - Middle Name:
Authorized Official - Last Name:KOCHEVAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-221-5090
Mailing Address - Street 1:1513 RIVERSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-4348
Mailing Address - Country:US
Mailing Address - Phone:970-221-5090
Mailing Address - Fax:970-221-1879
Practice Address - Street 1:1513 RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-4348
Practice Address - Country:US
Practice Address - Phone:970-221-5090
Practice Address - Fax:970-221-1879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-11
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty