Individual
KRISTA KOCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
633 GREENWAY RD SE, GLEN BURNIE, MD 21061-3713
(410) 761-1100
Mailing address
2118 SAINT HEATHER LN, GAMBRILLS, MD 21054-2138
(302) 632-3116
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
17662
MD
1223G0001X
General Practice Dentistry
8814
SC
Other
Enumeration date
04/13/2016
Last updated
11/21/2022
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