Provider Demographics
NPI:1790887826
Name:COCHELL, LORI E (DDS)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:E
Last Name:COCHELL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MS
Other - First Name:LORI
Other - Middle Name:E
Other - Last Name:LOGSDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3771 NEW TOWN BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-4358
Mailing Address - Country:US
Mailing Address - Phone:636-724-1199
Mailing Address - Fax:636-724-1218
Practice Address - Street 1:3771 NEW TOWN BLVD
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-4358
Practice Address - Country:US
Practice Address - Phone:636-724-1199
Practice Address - Fax:636-724-1218
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019026544122300000X
MO2004013332122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO20-5702402OtherPRIVATE DENTAL PRACTICE
IL019026544Medicaid