Provider Demographics
NPI:1417030297
Name:KOELLING, KARL DUANE (DDS)
Entity Type:Individual
Prefix:DR
First Name:KARL
Middle Name:DUANE
Last Name:KOELLING
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 EAST 2ND ST.
Mailing Address - Street 2:P.O. BOX 220
Mailing Address - City:KINGSLEY
Mailing Address - State:IA
Mailing Address - Zip Code:51028-0220
Mailing Address - Country:US
Mailing Address - Phone:712-378-2061
Mailing Address - Fax:712-378-2348
Practice Address - Street 1:12 EAST 2ND ST.
Practice Address - Street 2:
Practice Address - City:KINGSLEY
Practice Address - State:IA
Practice Address - Zip Code:51028-0220
Practice Address - Country:US
Practice Address - Phone:712-378-2061
Practice Address - Fax:712-378-2348
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA079771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice