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General NPI Number Information
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NPI Number | 1851892434
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Entity Type | Individual
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Provider Name | ANNE LAUREN KOCH DMD
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Gender | Female
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Dates
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Enumeration Date | 02/28/2018
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Last Update Date | 02/28/2018
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Provider Practice Location Address
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Address Line | 29 LEWIS BAY BLVD SUITE 4
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City | WEST YARMOUTH
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State | MA
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Zip | 02673
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Country | US
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Telephone | 631-219-9845
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 778
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City | WEST YARMOUTH
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State | MA
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Zip | 02673
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Country | US
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Telephone | 631-219-9845
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Fax |
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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 | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | DN13735
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License Number State | MA
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