Provider Demographics
NPI:1063500635
Name:KOCH, LAURA COLMAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:COLMAN
Last Name:KOCH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 PEACHTREE ST NE STE 100
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-3005
Mailing Address - Country:US
Mailing Address - Phone:404-249-1716
Mailing Address - Fax:404-249-1716
Practice Address - Street 1:1401 PEACHTREE ST NE STE 100
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-3005
Practice Address - Country:US
Practice Address - Phone:404-249-1716
Practice Address - Fax:404-249-1716
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN010803122300000X
GA108031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice