Provider Demographics
NPI:1417190620
Name:KOENIG, WILLIAM MARTIN JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:MARTIN
Last Name:KOENIG
Suffix:JR
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 1:8424 OLD HARFORD RD
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-4900
Mailing Address - Country:US
Mailing Address - Phone:410-665-3300
Mailing Address - Fax:
Practice Address - Street 1:8424 OLD HARFORD RD
Practice Address - Street 2:SUITE 2A
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21234-4900
Practice Address - Country:US
Practice Address - Phone:410-665-3300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-17
Last Update Date:2009-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMD5441122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist