NPIMap

Organization Active NPI

Samuel L. Koth, DDS, PC

  • General Practice Dentistry
  • Rock Valley, IA
National Provider Identifier
1760734263
Registry record updated Oct 8, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
08755 Issued in IA
Legal business name
SAMUEL L. KOTH, DDS, PC
Practice address
1220 21St Ave
Rock Valley, IA 51247-1420
Phone
(712) 476-2749
Fax
(712) 476-5374
NPI assigned
Oct 8, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 8, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Samuel Lee Koth, DDSNPI 1760794127
Title
Dentist/President
Phone
(712) 476-2749

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 08755 IA Primary

Addresses

Primary practice location

1220 21St Ave
Rock Valley, IA 51247-1420

Mailing address

1220 21St Ave
Rock Valley, IA 51247-1420
Phone (712) 476-2749

National Provider Directory

National Provider Directory

Locations

1220 21st Ave
Rock Valley, IA 51247
Phone (712) 476-2749

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1349654400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1349654400000",
    "number": "1760734263",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1220 21ST AVE",
            "city": "ROCK VALLEY",
            "state": "IA",
            "postal_code": "512471420",
            "telephone_number": "712-476-2749",
            "fax_number": "712-476-5374"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1220 21ST AVE",
            "city": "ROCK VALLEY",
            "state": "IA",
            "postal_code": "512471420",
            "telephone_number": "712-476-2749",
            "fax_number": "712-476-5374"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAMUEL L. KOTH, DDS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-08",
        "last_updated": "2012-10-08",
        "status": "A",
        "authorized_official_last_name": "KOTH",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "DENTIST/PRESIDENT",
        "authorized_official_telephone_number": "712-476-2749",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "IA",
            "license": "08755",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rock Valley, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.