Healthcare Provider Details

I. General information

NPI: 1255619797
Provider Name (Legal Business Name): PHILIP EDWARD COCHRAN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2011
Last Update Date: 08/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1066 CHELSEA AVENUE
NAPOLEON OH
43545
US

IV. Provider business mailing address

1066 CHELSEA AVENUE
NAPOLEON OH
43545
US

V. Phone/Fax

Practice location:
  • Phone: 419-599-4216
  • Fax: 419-599-8025
Mailing address:
  • Phone: 419-599-4216
  • Fax: 419-599-8025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12424
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: