MEDICARE: DR. WILLIAM R KOENIG DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	30013907	OH

General Provider Information

NPI Number	:	1346670460
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM R KOENIG DDS

Provider Business Mailing Address
First Line	:	7921 AUGUSTA LN
Second Line	:
City	:	CONCORD TWP
State	:	OH
Zip	:	44077-9193
Country	:	US
Telephone Number	:	440-352-7425
Fax Number	:

Provider Business Practice Location Address
First Line	:	1701 MENTOR AVE STE 12
Second Line	:
City	:	PAINESVILLE
State	:	OH
Zip	:	44077-1459
Country	:	US
Telephone Number	:	440-352-3223
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/26/2013
Last Update Date	:	11/26/2013

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