Provider Demographics
NPI:1659417020
Name:KOCHER, KENNETH H (DMD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:H
Last Name:KOCHER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10409 MONTGOMERY PKWY NE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-3852
Mailing Address - Country:US
Mailing Address - Phone:505-293-1100
Mailing Address - Fax:505-299-9637
Practice Address - Street 1:10409 MONTGOMERY PKWY NE
Practice Address - Street 2:SUITE 203
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-3852
Practice Address - Country:US
Practice Address - Phone:505-293-1100
Practice Address - Fax:505-299-9637
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM12041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice