Provider Demographics
NPI:1689757718
Name:KOCH, JOHN PAUL (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:PAUL
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 1:2311 HIGHLAND AVE S
Mailing Address - Street 2:SUITE 323
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-2972
Mailing Address - Country:US
Mailing Address - Phone:205-933-0323
Mailing Address - Fax:205-933-0367
Practice Address - Street 1:2311 HIGHLAND AVE S
Practice Address - Street 2:SUITE 323
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-2972
Practice Address - Country:US
Practice Address - Phone:205-933-0323
Practice Address - Fax:205-933-0367
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4938122300000X
GADN010802122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist