Provider Demographics
NPI:1962532630
Name:KOCH, MARK G (DDS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:G
Last Name:KOCH
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Gender:M
Credentials:DDS
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Mailing Address - Street 1:13123 E 16TH AVE
Mailing Address - Street 2:B240
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80045-7106
Mailing Address - Country:US
Mailing Address - Phone:720-777-4688
Mailing Address - Fax:720-777-7239
Practice Address - Street 1:13123 E 16TH AVE
Practice Address - Street 2:B240
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-7106
Practice Address - Country:US
Practice Address - Phone:720-777-6788
Practice Address - Fax:720-777-7239
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2011-01-03
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Provider Licenses
StateLicense IDTaxonomies
CO93531223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO12678520Medicaid