Provider Demographics
NPI:1487786240
Name:KOCHENDERFER, ROBERT LEE
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LEE
Last Name:KOCHENDERFER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10906 SOUTH SHORE DRIVE
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55441-4919
Mailing Address - Country:US
Mailing Address - Phone:763-545-1837
Mailing Address - Fax:
Practice Address - Street 1:10906 SOUTH SHORE DRIVE
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55441-4919
Practice Address - Country:US
Practice Address - Phone:763-545-1837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND10802122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist