=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811221302
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAILA OCHANA DDS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/30/2009
-----------------------------------------------------
Last Update Date | 03/09/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 85002 AIRPORT RD NW UNIT #130
-----------------------------------------------------
City | ROANOKE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24012
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-362-5437
-----------------------------------------------------
Fax | 540-362-8997
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 618 CHURCH ST SUITE 520
-----------------------------------------------------
City | NASHVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37219-2428
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-750-0342
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 0401413456
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------