Provider Demographics
NPI:1114707189
Name:CHRISTOPHER KOECHNER DMD
Entity Type:Organization
Organization Name:CHRISTOPHER KOECHNER DMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:J
Authorized Official - Last Name:KOECHNER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:618-364-2411
Mailing Address - Street 1:1373 YMCA DR
Mailing Address - Street 2:
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028-2617
Mailing Address - Country:US
Mailing Address - Phone:636-937-6565
Mailing Address - Fax:
Practice Address - Street 1:1373 YMCA DR
Practice Address - Street 2:
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-2617
Practice Address - Country:US
Practice Address - Phone:636-937-6565
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-05
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental