Healthcare Provider Details

I. General information

NPI: 1396496113
Provider Name (Legal Business Name): JOSH COCHRAN 11919, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2022
Last Update Date: 04/28/2022
Certification Date: 04/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11919 W SUNSET HIGHWAY
AIRWAY HEIGHTS WA
99001
US

IV. Provider business mailing address

13514 E 32ND AVE
SPOKANE VALLEY WA
99216-6002
US

V. Phone/Fax

Practice location:
  • Phone: 509-903-8719
  • Fax:
Mailing address:
  • Phone: 206-755-6436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: JOSHUA COCHRAN
Title or Position: OWNER
Credential: DMD
Phone: 509-475-1362