MEDICARE: DR. PETER PAUL KORCH III DMD

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	1223G0001X	General Practice Dentistry	DS-027847-L	PA

General Provider Information

NPI Number	:	1700889375
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER PAUL KORCH III DMD

Provider Business Mailing Address
First Line	:	PO BOX 1338
Second Line	:
City	:	NORTHERN CAMBRIA
State	:	PA
Zip	:	15714-3338
Country	:	US
Telephone Number	:	814-948-9650
Fax Number	:

Provider Business Practice Location Address
First Line	:	4200 CRAWFORD AVE
Second Line	:	SUITE 3
City	:	NORTHERN CAMBRIA
State	:	PA
Zip	:	15714-1370
Country	:	US
Telephone Number	:	814-948-9650
Fax Number	:

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

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	07/08/2007

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