Provider Demographics
NPI:1063626422
Name:COCHRAN, BRIAN GARY (DDS)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:GARY
Last Name:COCHRAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 CARDINAL PARK DR SE
Mailing Address - Street 2:SUITE 204-A
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20175-4448
Mailing Address - Country:US
Mailing Address - Phone:703-779-2296
Mailing Address - Fax:703-779-0602
Practice Address - Street 1:2 CARDINAL PARK DR SE
Practice Address - Street 2:SUITE 204-A
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20175-4448
Practice Address - Country:US
Practice Address - Phone:703-779-2296
Practice Address - Fax:703-779-0602
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014105861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA138753OtherBLUE CROSS BLUE SHIELD
VA1463842OtherUNITED CONCORDIA