Healthcare Provider Details

I. General information

NPI: 1629226774
Provider Name (Legal Business Name): JEFFREY B KOCHEVAR DDS MSD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2008
Last Update Date: 09/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4970 S 900 E STE. E
SALT LAKE CITY UT
84117-5776
US

IV. Provider business mailing address

4970 S 900 E STE. E
SALT LAKE CITY UT
84117-5776
US

V. Phone/Fax

Practice location:
  • Phone: 801-868-9722
  • Fax: 801-264-9662
Mailing address:
  • Phone: 801-868-9722
  • Fax: 801-264-9662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number6604918
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: