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General NPI Number Information
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NPI Number | 1174499818
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Entity Type | Organization
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Legal Business Name | JEREMY P. KOONTZ DMD, P.L.L.C.
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Dates
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Enumeration Date | 10/10/2025
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Last Update Date | 10/10/2025
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Provider Practice Location Address
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Address Line | 5100 GROVE ST STE B
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City | MARYSVILLE
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State | WA
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Zip | 98270-4492
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Country | US
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Telephone | 360-658-7750
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Fax | 360-658-1297
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Provider Business Mailing Address
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Address Line | 5100 GROVE ST STE B
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City | MARYSVILLE
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State | WA
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Zip | 98270-4492
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Country | US
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Telephone | 360-658-7750
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Fax | 360-658-1297
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Authorized Official
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Title or Position | OWNER
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Name | DR. JEREMY PARCO KOONTZ
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Credential | DMD
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Telephone | 360-658-7750
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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