Healthcare Provider Details

I. General information

NPI: 1255408340
Provider Name (Legal Business Name): BRYAN KENT COCHRAN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 12/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6256 YELLOWSTONE RD
CHEYENNE WY
82009-3432
US

IV. Provider business mailing address

6256 YELLOWSTONE RD
CHEYENNE WY
82009-3432
US

V. Phone/Fax

Practice location:
  • Phone: 402-483-7631
  • Fax:
Mailing address:
  • Phone: 307-635-3044
  • Fax: 307-637-8382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number6377
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number1033
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: