Provider Demographics
NPI:1942365762
Name:COCHRAN, TODD T (DMD, FAGD)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:T
Last Name:COCHRAN
Suffix:
Gender:M
Credentials:DMD, FAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5520 SONORA RD
Mailing Address - Street 2:
Mailing Address - City:HODGENVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42748-9627
Mailing Address - Country:US
Mailing Address - Phone:270-763-0492
Mailing Address - Fax:
Practice Address - Street 1:950 N MULBERRY ST
Practice Address - Street 2:SUITE 170
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-3612
Practice Address - Country:US
Practice Address - Phone:270-360-1084
Practice Address - Fax:270-360-8914
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY74291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice