Healthcare Provider Details

I. General information

NPI: 1700889375
Provider Name (Legal Business Name): PETER PAUL KORCH III DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 CRAWFORD AVE SUITE 3
NORTHERN CAMBRIA PA
15714-1370
US

IV. Provider business mailing address

PO BOX 1338
NORTHERN CAMBRIA PA
15714-3338
US

V. Phone/Fax

Practice location:
  • Phone: 814-948-9650
  • Fax:
Mailing address:
  • Phone: 814-948-9650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS-027847-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: