MEDICARE: DR. LORI E COCHELL DDS

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	122300000X	Dentist	019026544	IL
2	122300000X	Dentist	2004013332	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	20-5702402	OTHER	MO	PRIVATE DENTAL PRACTICE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790887826
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LORI E COCHELL DDS

Provider Business Mailing Address
First Line	:	3771 NEW TOWN BLVD
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63301-4358
Country	:	US
Telephone Number	:	636-724-1199
Fax Number	:	636-724-1218

Provider Business Practice Location Address
First Line	:	3771 NEW TOWN BLVD
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63301-4358
Country	:	US
Telephone Number	:	636-724-1199
Fax Number	:	636-724-1218

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

Provider Enumeration Date	:	09/01/2006
Last Update Date	:	07/08/2007

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