Organization
KENNETH BROCHIN, D.D.S., LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEBORAH S DETTERMAN (OFFICE MANAGER)
(419) 535-1066
Entity
Organization
Contact information
Practice address
4210 W CENTRAL AVE, OTTAWA HILLS, OH 43606-2270
(419) 535-1066
(419) 535-1379
Mailing address
4210 W CENTRAL AVE, OTTAWA HILLS, OH 43606-2270
(419) 535-1066
(419) 535-1379
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
15261
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0336023
—
OH
Enumeration date
08/18/2015
Last updated
08/18/2015
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