MEDICARE: DR. JEFFREY B KOCHEVAR DDS MSD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223E0200X	Endodontics	6604918	UT

General Provider Information

NPI Number	:	1629226774
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY B KOCHEVAR DDS MSD

Provider Business Mailing Address
First Line	:	4970 S 900 E
Second Line	:	STE. E
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84117-5776
Country	:	US
Telephone Number	:	801-868-9722
Fax Number	:	801-264-9662

Provider Business Practice Location Address
First Line	:	4970 S 900 E
Second Line	:	STE. E
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84117-5776
Country	:	US
Telephone Number	:	801-868-9722
Fax Number	:	801-264-9662

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/03/2008
Last Update Date	:	09/03/2008

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