Provider Demographics
NPI:1437365400
Name:KOETT, WILLIAM HARRY (DDS)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:HARRY
Last Name:KOETT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:WILLIAM
Other - Middle Name:H
Other - Last Name:KOETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2129 TARBOLTON CR
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95620
Mailing Address - Country:US
Mailing Address - Phone:916-984-0515
Mailing Address - Fax:916-817-4329
Practice Address - Street 1:25005 BLUE RAVINE RD
Practice Address - Street 2:STE 100
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630
Practice Address - Country:US
Practice Address - Phone:916-984-0515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC24564122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist