Healthcare Provider Details

I. General information

NPI: 1558584151
Provider Name (Legal Business Name): WILLIAM LEWIS KOCHENOUR II D.D.S.,M.S.,P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3005 ENTERPRISE RD E
CLEARWATER FL
33759-1304
US

IV. Provider business mailing address

3005 ENTERPRISE RD E
CLEARWATER FL
33759-1304
US

V. Phone/Fax

Practice location:
  • Phone: 727-796-2456
  • Fax: 727-796-8364
Mailing address:
  • Phone: 727-796-2456
  • Fax: 727-796-8364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDN0008889
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: