Individual
DR. JASON MANTLE KOCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
95 RAYWICK RD, ST MARY, KY 40063-8800
(270) 699-4074
Mailing address
100 CAMBRON DR, BARDSTOWN, KY 40004-2245
(502) 460-2976
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
7252
KY
Other
Enumeration date
10/31/2007
Last updated
10/31/2007
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