MEDICARE: DR. MICHAEL ANTHONY KOCH D.D.S.

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	1223E0200X	Endodontics	30-01-9288	OH

General Provider Information

NPI Number	:	1285613695
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL ANTHONY KOCH D.D.S.

Provider Business Mailing Address
First Line	:	PSC 9
Second Line	:	BOX 1751
City	:	APO
State	:	AE
Zip	:	09123
Country	:	DE
Telephone Number	:	011496561693844
Fax Number	:

Provider Business Practice Location Address
First Line	:	52 DENTAL SQUADRON
Second Line	:	UNIT 3690
City	:	APO
State	:	AE
Zip	:	09126
Country	:	DE
Telephone Number	:	011496565958193
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/13/2006
Last Update Date	:	07/10/2007

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Directions to “ DR. MICHAEL ANTHONY KOCH D.D.S.” Practice Location

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