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General NPI Number Information
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NPI Number | 1396880480
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Entity Type | Organization
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Legal Business Name | MARVIN C KOONCE DDS PC
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Dates
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Enumeration Date | 02/20/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 603 N MAIN ST
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City | SHELBYVILLE
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State | TN
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Zip | 37160-3210
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Country | US
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Telephone | 931-684-2445
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Fax | 931-684-6201
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Provider Business Mailing Address
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Address Line | PO BOX 741
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City | SHELBYVILLE
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State | TN
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Zip | 37162-0741
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Country | US
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Telephone | 931-684-2445
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Fax | 931-684-6201
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARVIN C KOONCE
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Credential | DDS
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Telephone | 931-684-2445
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DS2322
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License Number State | TN
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