Healthcare Provider Details

I. General information

NPI: 1083684104
Provider Name (Legal Business Name): ANTHONY JOSEPH KOAGEL DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: TONY JOSEPH KOAGEL DMD

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7768 CUMMING HWY STE 100
CANTON GA
30115-2982
US

IV. Provider business mailing address

1713 WESTON BRENT LN
EL PASO TX
79935-3013
US

V. Phone/Fax

Practice location:
  • Phone: 678-493-2204
  • Fax:
Mailing address:
  • Phone: 915-592-2097
  • Fax: 915-592-2853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN014219
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: