MEDICARE: JOEL R KOCH DDS

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	30016585	OH

General Provider Information

NPI Number	:	1740229392
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOEL R KOCH DDS

Provider Business Mailing Address
First Line	:	9655 CINCINNATI COLUMBUS RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45241-4120
Country	:	US
Telephone Number	:	513-779-2200
Fax Number	:	513-779-3422

Provider Business Practice Location Address
First Line	:	9655 CINCINNATI COLUMBUS RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45241-4120
Country	:	US
Telephone Number	:	513-779-2200
Fax Number	:	513-779-3422

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

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	07/08/2007

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