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General NPI Number Information
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NPI Number | 1396825998
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Entity Type | Organization
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Legal Business Name | MARK E. KOONMEN, DDS, MS, PC
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 03/24/2008
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Provider Practice Location Address
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Address Line | 1122 S LINDEN RD
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City | FLINT
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State | MI
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Zip | 48532-3437
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Country | US
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Telephone | 810-732-0640
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Fax | 810-732-2264
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Provider Business Mailing Address
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Address Line | 1122 S LINDEN RD
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City | FLINT
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State | MI
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Zip | 48532-3437
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Country | US
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Telephone | 810-732-0640
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Fax | 810-732-2264
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. MARK EDWARD KOONMEN
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Credential | DDS
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Telephone | 810-732-0640
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 13770
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License Number State | MI
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