Provider Demographics
NPI:1982789269
Name:DOUGLAS J. KOCH, D.D.S.,L.L.C.
Entity type:Organization
Organization Name:DOUGLAS J. KOCH, D.D.S.,L.L.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:KOCH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-663-0052
Mailing Address - Street 1:9354 CABBAGE RUN RD
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-2214
Mailing Address - Country:US
Mailing Address - Phone:301-845-7759
Mailing Address - Fax:
Practice Address - Street 1:85 THOMAS JOHNSON CT
Practice Address - Street 2:SUITE A
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4331
Practice Address - Country:US
Practice Address - Phone:301-663-0052
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD86871223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty