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NPI Code Detail

MEDICARE: DR. RYAN LAWRENCE KOCH DDS, MS

MEDICARE: DR. RYAN LAWRENCE KOCH DDS, MS
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
11223X0400XOrthodontics and Dentofacial Orthopedics Dentistry063114NY

General Provider Information

NPI Number : 1518640499
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RYAN LAWRENCE KOCH DDS, MS
Provider Business Mailing Address
First Line : 4376 LAKEVILLE RD
Second Line :
City : GENESEO
State : NY
Zip : 14454-9761
Country : US
Telephone Number : 585-243-3174
Fax Number :
Provider Business Practice Location Address
First Line : 4376 LAKEVILLE RD
Second Line :
City : GENESEO
State : NY
Zip : 14454-9761
Country : US
Telephone Number : 585-243-3174
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/08/2023
Last Update Date : 08/08/2023

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