Healthcare Provider Details

I. General information

NPI: 1508927849
Provider Name (Legal Business Name): CONRAD KOCH DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 WEYMAN RD SUITE 260
PITTSBURGH PA
15236-1520
US

IV. Provider business mailing address

300 WEYMAN RD SUITE 260
PITTSBURGH PA
15236-1520
US

V. Phone/Fax

Practice location:
  • Phone: 412-882-1320
  • Fax: 412-882-0167
Mailing address:
  • Phone: 412-882-1320
  • Fax: 412-882-0167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS018185L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: