Provider Demographics
NPI:1861475329
Name:KOCH, RICHARD L (DDS)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:L
Last Name:KOCH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:33801 1ST WAY S
Mailing Address - Street 2:STE 201
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-4546
Mailing Address - Country:US
Mailing Address - Phone:253-838-4770
Mailing Address - Fax:253-838-4779
Practice Address - Street 1:33801 1ST WAY S
Practice Address - Street 2:STE 201
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-4546
Practice Address - Country:US
Practice Address - Phone:253-838-4770
Practice Address - Fax:253-838-4779
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WA57981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice