Healthcare Provider Details

I. General information

NPI: 1316933773
Provider Name (Legal Business Name): DORON KOCHMAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 OFFICE PKWY TOBEY VILLAGE OFFICE PARK
PITTSFORD NY
14534-1749
US

IV. Provider business mailing address

90 OFFICE PKWY TOBEY VILLAGE OFFICE PARK
PITTSFORD NY
14534-1749
US

V. Phone/Fax

Practice location:
  • Phone: 585-383-0640
  • Fax: 585-383-1463
Mailing address:
  • Phone: 585-383-0640
  • Fax: 585-383-1463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number36119
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: