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General NPI Number Information
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NPI Number | 1568684132
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Entity Type | Organization
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Legal Business Name | KEITH W. KOCH, D.D.S.,P.C.
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4376 LAKEVILLE RD.
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City | GENESEO
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State | NY
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Zip | 14454
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Country | US
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Telephone | 585-243-3174
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Fax | 585-243-3333
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Provider Business Mailing Address
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Address Line | 4376 LAKEVILLE RD.
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City | GENESEO
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State | NY
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Zip | 14454
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Country | US
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Telephone | 585-243-3174
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Fax | 585-243-3333
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Authorized Official
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Title or Position | OWNER
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Name | DR. KEITH WILLIAM KOCH
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Credential | D.D.S.
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Telephone | 585-243-3174
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 040183-1
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License Number State | NY
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