Provider Demographics
NPI:1821106949
Name:KOCHAN, KELLY (DDS)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:
Last Name:KOCHAN
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 1:344 MAIN STREET
Mailing Address - Street 2:SUITE 002
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549
Mailing Address - Country:US
Mailing Address - Phone:914-244-4414
Mailing Address - Fax:914-244-4404
Practice Address - Street 1:344 MAIN STREET
Practice Address - Street 2:SUITE 002
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549
Practice Address - Country:US
Practice Address - Phone:914-244-4414
Practice Address - Fax:914-244-4404
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041287122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist