MEDICARE: DR. JAMES L KOEHLER JR. DMD

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	8705311	UT
2	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	12344	NC

General Provider Information

NPI Number	:	1821424185
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES L KOEHLER JR. DMD

Provider Business Mailing Address
First Line	:	4323 HILL STREET
Second Line	:	US ARMY DENTAL ACTIVITY
City	:	FORT JACKSON
State	:	SC
Zip	:	29207-6022
Country	:	US
Telephone Number	:	803-751-6213
Fax Number	:	803-751-6886

Provider Business Practice Location Address
First Line	:	BLD B-6837 NORMANDY DRIVE
Second Line	:	US ARMY DENTAL ACTIVITY
City	:	FORT BRAGG
State	:	NC
Zip	:	28301-6022
Country	:	US
Telephone Number	:	617-780-6125
Fax Number	:

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

Provider Enumeration Date	:	09/18/2013
Last Update Date	:	09/13/2024

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