Provider Demographics
NPI:1992830350
Name:KOSCHEL, LEROY W (DDS)
Entity Type:Individual
Prefix:DR
First Name:LEROY
Middle Name:W
Last Name:KOSCHEL
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 1:5151 PLANK RD STE 17A
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70805-3501
Mailing Address - Country:US
Mailing Address - Phone:225-355-3070
Mailing Address - Fax:225-355-6305
Practice Address - Street 1:5151 PLANK RD
Practice Address - Street 2:SUITE. 17-A
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70805-3501
Practice Address - Country:US
Practice Address - Phone:225-355-3070
Practice Address - Fax:225-355-6305
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA48911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1880973Medicaid
LA1848913Medicaid
LA1848913Medicaid