Provider Demographics
NPI:1609974104
Name:COCHRAN, JORDAN ELAIN (DDS)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:ELAIN
Last Name:COCHRAN
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 1:4014 FAIRACRES RD
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68845-2325
Mailing Address - Country:US
Mailing Address - Phone:308-234-5112
Mailing Address - Fax:
Practice Address - Street 1:4106 6TH AVE
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845-3395
Practice Address - Country:US
Practice Address - Phone:308-237-3479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE65511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47055213001Medicaid