Provider Demographics
NPI:1073834073
Name:KOONING, CHRISTOPHER D (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:D
Last Name:KOONING
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15962 BOONES FERRY RD STE 105
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-4359
Mailing Address - Country:US
Mailing Address - Phone:503-675-4594
Mailing Address - Fax:503-675-3503
Practice Address - Street 1:15962 BOONES FERRY RD STE 105
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-4359
Practice Address - Country:US
Practice Address - Phone:503-675-4594
Practice Address - Fax:503-675-3503
Is Sole Proprietor?:No
Enumeration Date:2010-06-14
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD9420122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist