=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477784254
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COCHRANE DENTAL ASSOCIATES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/28/2009
-----------------------------------------------------
Last Update Date | 07/28/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 264 ELM ST SUITE 11
-----------------------------------------------------
City | NORTHAMPTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01060-2857
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-584-1301
-----------------------------------------------------
Fax | 413-584-1301
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 264 ELM ST SUITE 11
-----------------------------------------------------
City | NORTHAMPTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01060-2857
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-584-1301
-----------------------------------------------------
Fax | 413-584-1301
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. REBECCA L COCHRANE
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 413-584-1301
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 22043
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------