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General NPI Number Information
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NPI Number | 1376353540
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Entity Type | Individual
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Provider Name | BREANNA KAITLYN COCHRAN RDH
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Gender | Female
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Dates
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Enumeration Date | 01/09/2025
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Last Update Date | 01/09/2025
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Provider Practice Location Address
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Address Line | 9625 PROMINENT PT STE 100
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City | COLORADO SPRINGS
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State | CO
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Zip | 80924-5005
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Country | US
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Telephone | 719-495-5748
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Fax |
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Provider Business Mailing Address
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Address Line | 3513 SAGUARO CIR
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City | COLORADO SPRINGS
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State | CO
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Zip | 80925-1179
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Country | US
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Telephone | 910-797-8180
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | DH.002027165
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License Number State | CO
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