IndividualActive
Bradley Koch, D.D.S.
NPI 1013921196 · Oral and Maxillofacial Surgery (Dentist) · Green Bay, WI
Provider details
- NPI number
- 1013921196
- Entity type
- Individual
- Primary specialty
- Oral and Maxillofacial Surgery (Dentist)Dental Providers
- Credential
- D.D.S.
- Sex
- Male
- Sole proprietor
- No
- License
- 4005-015 (WI)
Specialties & taxonomies
Dental Providers
Practice location
2353 S Ridge Rd
Green Bay, WI 54304-5069
Phone: (920) 499-0471
Fax: (920) 499-8312
Approximate (ZIP-level) locationGet directions
Mailing address
2353 S Ridge Rd
Green Bay, WI 54304-5069
Registry dates
- Enumerated
- 2006-07-27
- Last updated
- 2007-07-08
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.