MEDICARE: DR. JOHN BRUCE KOCHEVAR 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	131926	UT

General Provider Information

NPI Number	:	1982783957
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN BRUCE KOCHEVAR DDS

Provider Business Mailing Address
First Line	:	4970 SO 900 E STE E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84117
Country	:	US
Telephone Number	:	801-268-9722
Fax Number	:	801-264-9662

Provider Business Practice Location Address
First Line	:	4970 SO 900 E STE E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84117
Country	:	US
Telephone Number	:	801-268-9722
Fax Number	:	801-264-9662

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

Provider Enumeration Date	:	11/02/2006
Last Update Date	:	07/08/2007

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