Provider Demographics
NPI:1336243633
Name:KOSCHAK, SETH RAMSEY (DDS)
Entity Type:Individual
Prefix:
First Name:SETH
Middle Name:RAMSEY
Last Name:KOSCHAK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3215 GREEN RIDGE DR
Mailing Address - Street 2:RAMSEY KOSCHAK DDS
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76904
Mailing Address - Country:US
Mailing Address - Phone:325-942-1616
Mailing Address - Fax:325-942-6465
Practice Address - Street 1:3215 GREEN RIDGE DR
Practice Address - Street 2:RAMSEY KOSCHAK DDS
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76904
Practice Address - Country:US
Practice Address - Phone:325-942-1616
Practice Address - Fax:325-942-6465
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX122041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX820702OtherBLUE CROSS
TX872932OtherCONCORDIA