Healthcare Provider Details

I. General information

NPI: 1023017597
Provider Name (Legal Business Name): RICHARD H KOCH D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 01/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10101 E HAMPDEN AVE
DENVER CO
80231-4958
US

IV. Provider business mailing address

10101 E HAMPDEN AVE
DENVER CO
80231-4948
US

V. Phone/Fax

Practice location:
  • Phone: 303-671-0101
  • Fax: 303-671-9603
Mailing address:
  • Phone: 303-671-0101
  • Fax: 303-671-9603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number06545
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: