Provider Demographics
NPI:1609388651
Name:KOCH, JOSEPH H (DMD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:H
Last Name:KOCH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 BUTLER PIKE
Mailing Address - Street 2:
Mailing Address - City:MERCER
Mailing Address - State:PA
Mailing Address - Zip Code:16137-5653
Mailing Address - Country:US
Mailing Address - Phone:724-662-1837
Mailing Address - Fax:
Practice Address - Street 1:801 BUTLER PIKE
Practice Address - Street 2:
Practice Address - City:MERCER
Practice Address - State:PA
Practice Address - Zip Code:16137-5653
Practice Address - Country:US
Practice Address - Phone:724-662-1837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-31
Last Update Date:2017-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS022139-L1223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health