Healthcare Provider Details

I. General information

NPI: 1689757718
Provider Name (Legal Business Name): JOHN PAUL KOCH DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 05/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2311 HIGHLAND AVE S SUITE 323
BIRMINGHAM AL
35205-2972
US

IV. Provider business mailing address

2311 HIGHLAND AVE S SUITE 323
BIRMINGHAM AL
35205-2972
US

V. Phone/Fax

Practice location:
  • Phone: 205-933-0323
  • Fax: 205-933-0367
Mailing address:
  • Phone: 205-933-0323
  • Fax: 205-933-0367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number4938
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN010802
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: