MEDICARE: DR. BRADLEY STEWART COCHRAN D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	15901	TX

General Provider Information

NPI Number	:	1114021664
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRADLEY STEWART COCHRAN D.D.S.

Provider Business Mailing Address
First Line	:	117 W 2ND ST
Second Line	:	P.O. BOX 1546
City	:	DENVER CITY
State	:	TX
Zip	:	79323-3101
Country	:	US
Telephone Number	:	806-592-3468
Fax Number	:	806-592-7566

Provider Business Practice Location Address
First Line	:	117 W 2ND ST
Second Line	:
City	:	DENVER CITY
State	:	TX
Zip	:	79323-3101
Country	:	US
Telephone Number	:	806-592-3468
Fax Number	:	806-592-7566

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2006
Last Update Date	:	07/09/2007

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