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General NPI Number Information
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NPI Number | 1447626049
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Entity Type | Organization
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Legal Business Name | KENNETH BROCHIN, D.D.S., LLC
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Dates
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Enumeration Date | 08/18/2015
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Last Update Date | 08/18/2015
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Provider Practice Location Address
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Address Line | 4210 W CENTRAL AVE
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City | OTTAWA HILLS
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State | OH
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Zip | 43606-2270
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Country | US
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Telephone | 419-535-1066
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Fax | 419-535-1379
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Provider Business Mailing Address
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Address Line | 4210 W CENTRAL AVE
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City | OTTAWA HILLS
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State | OH
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Zip | 43606-2270
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Country | US
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Telephone | 419-535-1066
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Fax | 419-535-1379
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | DEBORAH S DETTERMAN
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Credential |
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Telephone | 419-535-1066
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 15261
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License Number State | OH
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