Healthcare Provider Details

I. General information

NPI: 1578285086
Provider Name (Legal Business Name): NICHOLAS KOOGLER DDS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2022
Last Update Date: 11/03/2023
Certification Date: 11/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 LAKE BELLEVUE DR STE 250
BELLEVUE WA
98005-2478
US

IV. Provider business mailing address

7219 221ST AVE NE
REDMOND WA
98053-5927
US

V. Phone/Fax

Practice location:
  • Phone: 425-209-0700
  • Fax:
Mailing address:
  • Phone: 614-371-1830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: NICHOLAS JAMES KOOGLER
Title or Position: OWNER
Credential: DDS
Phone: 614-371-1830