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General NPI Number Information
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NPI Number | 1578285086
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Entity Type | Organization
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Legal Business Name | NICHOLAS KOOGLER DDS PLLC
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Dates
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Enumeration Date | 09/13/2022
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Last Update Date | 11/03/2023
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Provider Practice Location Address
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Address Line | 40 LAKE BELLEVUE DR STE 250
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City | BELLEVUE
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State | WA
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Zip | 98005-2478
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Country | US
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Telephone | 425-209-0700
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Fax |
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Provider Business Mailing Address
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Address Line | 7219 221ST AVE NE
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City | REDMOND
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State | WA
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Zip | 98053-5927
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Country | US
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Telephone | 614-371-1830
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | NICHOLAS JAMES KOOGLER
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Credential | DDS
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Telephone | 614-371-1830
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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