Healthcare Provider Details

I. General information

NPI: 1659453496
Provider Name (Legal Business Name): GEORGE S. COCHRAN D.D.S., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 11/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1066 CHELSEA AVE
NAPOLEON OH
43545-1202
US

IV. Provider business mailing address

1066 CHELSEA AVE
NAPOLEON OH
43545-1202
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 Number14651
License Number StateOH

VIII. Authorized Official

Name: DR. GEORGE STEPHEN COCHRAN
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 419-599-4216