Provider Demographics
NPI:1093826208
Name:O KOON, HOWARD BURTON (DMD)
Entity Type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:BURTON
Last Name:O KOON
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 1:4122 SHELBYVILLE RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207
Mailing Address - Country:US
Mailing Address - Phone:502-897-1571
Mailing Address - Fax:502-894-2270
Practice Address - Street 1:4122 SHELBYVILLE RD
Practice Address - Street 2:SUITE D
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207
Practice Address - Country:US
Practice Address - Phone:502-897-1571
Practice Address - Fax:502-894-2270
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3521122300000X
KY1521223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered1223P0300XDental ProvidersDentistPeriodontics