Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | DS022139-L | PA |
NPI | 1609388651 |
---|---|
Provider Name | Joseph H Koch |
First Address | Mercer, PA 16137-5653 |
Second Address | Mercer, PA 16137-5653 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2017 |
Last Update Date | 31/10/2017 |