Provider Demographics
NPI:1992020986
Name:WILLIAM L. KOCHENOUR D.D.S.,M.S.
Entity Type:Organization
Organization Name:WILLIAM L. KOCHENOUR D.D.S.,M.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:L
Authorized Official - Last Name:KOCHENOUR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS,MS
Authorized Official - Phone:727-796-2456
Mailing Address - Street 1:3005 ENTERPRISE RD E
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33759-1304
Mailing Address - Country:US
Mailing Address - Phone:727-796-2456
Mailing Address - Fax:727-796-8364
Practice Address - Street 1:3005 ENTERPRISE RD E
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33759-1304
Practice Address - Country:US
Practice Address - Phone:727-796-2456
Practice Address - Fax:727-796-8364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-01
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN133111223P0221X
FLDN00088891223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL072684200-FLMedicaid