Provider Demographics
NPI:1245550557
Name:DAVIS, MICHELLE KOCH (DMD)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:KOCH
Last Name:DAVIS
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 1:7800 PARKWAY DR
Mailing Address - Street 2:
Mailing Address - City:LEEDS
Mailing Address - State:AL
Mailing Address - Zip Code:35094-2119
Mailing Address - Country:US
Mailing Address - Phone:205-699-8583
Mailing Address - Fax:
Practice Address - Street 1:7800 PARKWAY DR
Practice Address - Street 2:
Practice Address - City:LEEDS
Practice Address - State:AL
Practice Address - Zip Code:35094-2119
Practice Address - Country:US
Practice Address - Phone:205-699-8583
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-09
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL57711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice