Healthcare Provider Details

I. General information

NPI: 1609786763
Provider Name (Legal Business Name): ANNA DANIELLE KOON DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 ANCHORAGE POINT DR
WARSAW IN
46580-2282
US

IV. Provider business mailing address

13822 LIBERTY MILLS RD
FORT WAYNE IN
46814-9433
US

V. Phone/Fax

Practice location:
  • Phone: 800-342-5653
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12015121A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: