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General NPI Number Information
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NPI Number | 1700171303
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Entity Type | Individual
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Provider Name | MARY KATHERINE KOCHENOUR D.M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/13/2011
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Last Update Date | 07/03/2019
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Provider Practice Location Address
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Address Line | 1 PERKINS SQ
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City | AKRON
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State | OH
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Zip | 44308-1063
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Country | US
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Telephone | 330-543-0070
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Fax | 330-543-9060
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Provider Business Mailing Address
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Address Line | 1 PERKINS SQ
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City | AKRON
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State | OH
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Zip | 44308-1063
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Country | US
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Telephone | 330-543-0070
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Fax | 330-543-9060
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 2011016747
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 30.024188
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License Number State | OH
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