Provider Demographics
NPI:1376353540
Name:COCHRAN, BREANNA KAITLYN (RDH)
Entity type:Individual
Prefix:MRS
First Name:BREANNA
Middle Name:KAITLYN
Last Name:COCHRAN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3513 SAGUARO CIR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80925-1179
Mailing Address - Country:US
Mailing Address - Phone:910-797-8180
Mailing Address - Fax:
Practice Address - Street 1:9625 PROMINENT PT STE 100
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80924-5005
Practice Address - Country:US
Practice Address - Phone:719-495-5748
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-09
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODH.002027165124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist