Healthcare Provider Details

I. General information

NPI: 1033252382
Provider Name (Legal Business Name): PETER ALLEN KOCH DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1065 MAIN STREET SUITE C
FISHKILL NY
12524
US

IV. Provider business mailing address

1065 MAIN STREET SUITE C
FISHKILL NY
12524
US

V. Phone/Fax

Practice location:
  • Phone: 845-894-5502
  • Fax: 845-894-3247
Mailing address:
  • Phone: 845-894-5502
  • Fax: 845-894-3247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number34293
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: