Provider Demographics
NPI:1790819548
Name:COCHELL FAMILY DENTISTRY PC
Entity type:Organization
Organization Name:COCHELL FAMILY DENTISTRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTEL
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:COCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-585-8688
Mailing Address - Street 1:2225 MISSION ST SE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-1297
Mailing Address - Country:US
Mailing Address - Phone:503-585-8688
Mailing Address - Fax:503-763-8719
Practice Address - Street 1:2225 MISSION ST SE
Practice Address - Street 2:SUITE 100
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-1297
Practice Address - Country:US
Practice Address - Phone:503-585-8688
Practice Address - Fax:503-763-8719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD86131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty