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General NPI Number Information
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NPI Number | 1629172671
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Entity Type | Individual
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Provider Name | DENISE LYNN TERESE-KOCH DDS
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Gender | Female
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Dates
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Enumeration Date | 09/11/2006
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Last Update Date | 01/17/2019
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Provider Practice Location Address
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Address Line | 616 MARRIOTT DR
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City | NASHVILLE
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State | TN
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Zip | 37214-5048
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Country | US
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Telephone | 629-802-3221
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Fax | 630-325-9299
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Provider Business Mailing Address
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Address Line | 616 MARRIOTT DR
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City | NASHVILLE
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State | TN
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Zip | 37214-5048
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Country | US
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Telephone | 629-802-3221
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Fax | 630-325-9299
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 10060
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License Number State | TN
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