Individual
DR. SAMUEL LEE KOTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1220 21ST AVE, ROCK VALLEY, IA 51247-1420
(712) 476-2749
Mailing address
1220 21ST AVE, ROCK VALLEY, IA 51247-1420
(712) 476-2749
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
08755
IA
Other
Enumeration date
07/13/2010
Last updated
07/13/2010
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