Healthcare Provider Details

I. General information

NPI: 1790280758
Provider Name (Legal Business Name): AMBER DENTAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2018
Last Update Date: 11/06/2025
Certification Date: 11/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 E ROOSEVELT RD
WHEATON IL
60187-5526
US

IV. Provider business mailing address

319 E ROOSEVELT RD
WHEATON IL
60187-5526
US

V. Phone/Fax

Practice location:
  • Phone: 630-665-5555
  • Fax:
Mailing address:
  • Phone: 630-665-5555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number019019448
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL KOEHNE
Title or Position: PRESIDENT/DENTIST
Credential: DDS
Phone: 630-665-5555