Provider Demographics
NPI:1740229392
Name:KOCH, JOEL R (DDS)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:R
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 1:9655 CINCINNATI COLUMBUS RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45241-4120
Mailing Address - Country:US
Mailing Address - Phone:513-779-2200
Mailing Address - Fax:513-779-3422
Practice Address - Street 1:9655 CINCINNATI COLUMBUS RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45241-4120
Practice Address - Country:US
Practice Address - Phone:513-779-2200
Practice Address - Fax:513-779-3422
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300165851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice