MEDICARE: KENNETH P. TRCH, DDS, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	019026990	IL

General Provider Information

NPI Number	:	1225494107
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KENNETH P. TRCH, DDS, P.C.

Provider Business Mailing Address
First Line	:	127 HAMILTON ST
Second Line	:
City	:	GENEVA
State	:	IL
Zip	:	60134-4516
Country	:	US
Telephone Number	:	630-232-0895
Fax Number	:	630-232-0051

Provider Business Practice Location Address
First Line	:	127 HAMILTON ST
Second Line	:
City	:	GENEVA
State	:	IL
Zip	:	60134-4516
Country	:	US
Telephone Number	:	630-232-0895
Fax Number	:	630-232-0051

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. KENNETH PAUL TRCH
Credential	:	DDS
Telephone Number	:	630-232-0895

Provider Enumeration Date	:	01/08/2016
Last Update Date	:	01/08/2016

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