Kenneth Brochin, D.D.S., LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

15261 Issued in OH

Legal business name

KENNETH BROCHIN, D.D.S., LLC

Practice address

4210 W Central Ave
Ottawa Hills, OH 43606-2270

Phone

(419) 535-1066

Fax

(419) 535-1379

NPI assigned

Aug 18, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Deborah S Detterman

Title

Office Manager

Phone

(419) 535-1066

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kenneth Brochin, DDS

  • General Practice Dentistry
  • Ottawa Hills, OH
  • NPI 1568527802
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1439856000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1439856000000",
    "number": "1447626049",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4210 W CENTRAL AVE",
            "city": "OTTAWA HILLS",
            "state": "OH",
            "postal_code": "436062270",
            "telephone_number": "419-535-1066",
            "fax_number": "419-535-1379"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4210 W CENTRAL AVE",
            "city": "OTTAWA HILLS",
            "state": "OH",
            "postal_code": "436062270",
            "telephone_number": "419-535-1066",
            "fax_number": "419-535-1379"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENNETH BROCHIN, D.D.S., LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-18",
        "last_updated": "2015-08-18",
        "status": "A",
        "authorized_official_last_name": "DETTERMAN",
        "authorized_official_first_name": "DEBORAH",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "419-535-1066"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "OH",
            "license": "15261",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0336023",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kaleena Maire Fisher
• Eric David Fulcher, M.D.
• Stacy H Harr, M.D.
• Ashley Nicole Jones, PA-C
• Alamdar H Kazmi, M.D.
• Alyssa Lopez
• Dalal Mahmoud
• Margaret Hearn Mohan, ED.S
• Olivia Nickoson-Massey
• Lurissa Osmialowski, FNP-C

• General Practice Dentistry in Ottawa Hills, OH
• Providers in Ottawa Hills, OH by specialty
• General Practice Dentistry in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.