Provider Demographics
NPI:1942754783
Name:HEATHER R KOCH DDS PLLC
Entity Type:Organization
Organization Name:HEATHER R KOCH DDS PLLC
Other - Org Name:HINTON FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:KOCH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:405-554-1018
Mailing Address - Street 1:PO BOX 47
Mailing Address - Street 2:
Mailing Address - City:HINTON
Mailing Address - State:OK
Mailing Address - Zip Code:73047-0047
Mailing Address - Country:US
Mailing Address - Phone:405-554-1018
Mailing Address - Fax:
Practice Address - Street 1:1902 N BROADWAY
Practice Address - Street 2:
Practice Address - City:HINTON
Practice Address - State:OK
Practice Address - Zip Code:73047
Practice Address - Country:US
Practice Address - Phone:405-554-1018
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-10
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6195122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty