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General NPI Number Information
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NPI Number | 1578633665
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Entity Type | Organization
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Legal Business Name | TED B KOESTER DMD PC
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Dates
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Enumeration Date | 11/08/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 111 SOUTH FIRST STREET
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City | EFFINGHAM
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State | IL
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Zip | 62401
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Country | US
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Telephone | 217-342-4494
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Fax | 217-347-5344
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Provider Business Mailing Address
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Address Line | 111 SOUTH FIRST STREET
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City | EFFINGHAM
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State | IL
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Zip | 62401
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Country | US
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Telephone | 217-342-4494
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Fax | 217-347-5344
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Authorized Official
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Title or Position | DMD
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Name | MR. TED KOESTER
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Credential | DMD
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Telephone | 217-342-4494
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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 | IL
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