Provider Demographics
NPI:1023117629
Name:KOCH, PHILIP ERICH (DMD)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:ERICH
Last Name:KOCH
Suffix:
Gender:M
Credentials:DMD
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Mailing Address - Street 1:1221 SHERWOOD PARK DRIVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501
Mailing Address - Country:US
Mailing Address - Phone:770-534-1492
Mailing Address - Fax:770-534-8309
Practice Address - Street 1:1221 SHERWOOD PARK DRIVE
Practice Address - Street 2:SUITE B
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501
Practice Address - Country:US
Practice Address - Phone:770-534-1492
Practice Address - Fax:770-534-8309
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2017-03-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA82791223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery