Provider Demographics
NPI:1528575339
Name:CHRISTOPHER D KOONING, DMD PC
Entity Type:Organization
Organization Name:CHRISTOPHER D KOONING, DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:KOONING
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-675-4594
Mailing Address - Street 1:15962 BOONES FERRY RD STE 105
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-4359
Mailing Address - Country:US
Mailing Address - Phone:503-675-4594
Mailing Address - Fax:
Practice Address - Street 1:15962 BOONES FERRY RD STE 105
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-4359
Practice Address - Country:US
Practice Address - Phone:503-675-4594
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-02
Last Update Date:2018-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD9420332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies