MEDICARE: JOSHUA RIVER COCHRAN, PLLC

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	261QD0000X	Dental Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DE60764117	OTHER	WA	STACEY MCDONALD
2	DE00009401	OTHER	WA	ANDREW MARTINSSEN

General Provider Information

NPI Number	:	1578130670
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOSHUA RIVER COCHRAN, PLLC

Provider Business Mailing Address
First Line	:	13514 E 32ND AVE
Second Line	:
City	:	SPOKANE VALLEY
State	:	WA
Zip	:	99216-6002
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	625 B ST
Second Line	:
City	:	CHENEY
State	:	WA
Zip	:	99004-1768
Country	:	US
Telephone Number	:	509-960-6020
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. BRYANT ZOLLINGER
Credential	:	DDS
Telephone Number	:	509-808-8815

Provider Enumeration Date	:	06/07/2021
Last Update Date	:	06/07/2021

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