Provider Demographics
NPI:1770870297
Name:KOCH, COREY ANN (DDS)
Entity type:Individual
Prefix:DR
First Name:COREY
Middle Name:ANN
Last Name:KOCH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 W WORLEY ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-2037
Mailing Address - Country:US
Mailing Address - Phone:573-214-2314
Mailing Address - Fax:573-607-2885
Practice Address - Street 1:1001 W WORLEY ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-2037
Practice Address - Country:US
Practice Address - Phone:573-214-2314
Practice Address - Fax:573-607-2885
Is Sole Proprietor?:No
Enumeration Date:2011-07-05
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20110173471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice