Provider Demographics
NPI:1558548495
Name:DAVID KOEHN D. D. S. INC.
Entity Type:Organization
Organization Name:DAVID KOEHN D. D. S. INC.
Other - Org Name:EL DORADO ENDODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:KOEHN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:916-941-9888
Mailing Address - Street 1:1158 SUNCAST LN
Mailing Address - Street 2:STE #1
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-9326
Mailing Address - Country:US
Mailing Address - Phone:916-941-9888
Mailing Address - Fax:916-358-5638
Practice Address - Street 1:1158 SUNCAST LN
Practice Address - Street 2:STE #1
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-9326
Practice Address - Country:US
Practice Address - Phone:916-941-9888
Practice Address - Fax:916-358-5638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-23
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA489321223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty