Healthcare Provider Details

I. General information

NPI: 1821104555
Provider Name (Legal Business Name): ROBERT ALLEN KOCH D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 SCRIPPS DR SUITE 9
SACRAMENTO CA
95825-6316
US

IV. Provider business mailing address

103 SCRIPPS DR SUITE 9
SACRAMENTO CA
95825-6316
US

V. Phone/Fax

Practice location:
  • Phone: 916-929-0485
  • Fax: 916-929-5007
Mailing address:
  • Phone: 916-929-0485
  • Fax: 916-929-5007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number31815
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: