Provider Demographics
NPI:1760628515
Name:KOCH, DANIELE BRESSANELLI (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANIELE
Middle Name:BRESSANELLI
Last Name:KOCH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:DANIELE
Other - Middle Name:B
Other - Last Name:KOCH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:3815 SW 8TH ST
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-3001
Mailing Address - Country:US
Mailing Address - Phone:305-443-7501
Mailing Address - Fax:305-443-2888
Practice Address - Street 1:1611 NW 12TH AVE FL ACC
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1005
Practice Address - Country:US
Practice Address - Phone:305-585-6857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-29
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLDN191221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program