Individual
KENNETH BROCHIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
4210 W CENTRAL AVE, OTTAWA HILLS, OH 43606-2207
(419) 535-1066
(419) 535-1379
Mailing address
4210 W CENTRAL AVE, OTTAWA HILLS, OH 43606-2207
(419) 535-1066
(419) 535-1379
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
042386
NY
1223G0001X
General Practice Dentistry
Primary
15261
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01895
PARAMOUNT HEALTH CARE
OH
05
—
0336023
—
OH
01
—
34-1389351
TAX ID #
OH
01
—
818060
WORKERS COMP POLICY #
OH
Enumeration date
12/27/2006
Last updated
06/11/2009
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