Provider Demographics
NPI:1245518059
Name:JOCHIM, BRIAN (DMD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:JOCHIM
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 1:8400 NE VANCOUVER MALL LOOP STE 105
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662-6672
Mailing Address - Country:US
Mailing Address - Phone:360-219-9616
Mailing Address - Fax:
Practice Address - Street 1:1440 N LOMBARD ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97217-5533
Practice Address - Country:US
Practice Address - Phone:971-242-4355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-27
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60446726122300000X, 1223P0221X
ORD9994122300000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program