Provider Demographics
NPI:1851892434
Name:KOCH, ANNE LAUREN (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANNE
Middle Name:LAUREN
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:PO BOX 778
Mailing Address - Street 2:
Mailing Address - City:WEST YARMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02673
Mailing Address - Country:US
Mailing Address - Phone:631-219-9845
Mailing Address - Fax:
Practice Address - Street 1:29 LEWIS BAY BLVD
Practice Address - Street 2:SUITE 4
Practice Address - City:WEST YARMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02673
Practice Address - Country:US
Practice Address - Phone:631-219-9845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-28
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN137351223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics