Healthcare Provider Details

I. General information

NPI: 1740177435
Provider Name (Legal Business Name): NATALIE EVE KOCHANOWSKI DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2025
Last Update Date: 06/23/2025
Certification Date: 06/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4090 JILES RD NW
KENNESAW GA
30144-1105
US

IV. Provider business mailing address

3699 LENOX RD NE APT 213
ATLANTA GA
30305-3588
US

V. Phone/Fax

Practice location:
  • Phone: 678-915-9496
  • Fax:
Mailing address:
  • Phone: 971-266-9096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN123813
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: