Provider Demographics
NPI:1033252382
Name:KOCH, PETER ALLEN (DDS)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:ALLEN
Last Name:KOCH
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 1:1065 MAIN STREET
Mailing Address - Street 2:SUITE C
Mailing Address - City:FISHKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12524
Mailing Address - Country:US
Mailing Address - Phone:845-894-5502
Mailing Address - Fax:845-894-3247
Practice Address - Street 1:1065 MAIN STREET
Practice Address - Street 2:SUITE C
Practice Address - City:FISHKILL
Practice Address - State:NY
Practice Address - Zip Code:12524
Practice Address - Country:US
Practice Address - Phone:845-894-5502
Practice Address - Fax:845-894-3247
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY34293122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist