Healthcare Provider Details

I. General information

NPI: 1760535934
Provider Name (Legal Business Name): HANS R KOENIG DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 03/24/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W AIRPORT BLVD
SANFORD FL
32773-5489
US

IV. Provider business mailing address

400 W AIRPORT BLVD
SANFORD FL
32773-5489
US

V. Phone/Fax

Practice location:
  • Phone: 407-665-3345
  • Fax: 407-665-3104
Mailing address:
  • Phone: 407-665-3345
  • Fax: 407-665-3104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number036822
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN18472
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: