Provider Demographics
NPI:1578285086
Name:NICHOLAS KOOGLER DDS PLLC
Entity Type:Organization
Organization Name:NICHOLAS KOOGLER DDS PLLC
Other - Org Name:WASHINGTON CENTER FOR SLEEP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:KOOGLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:614-371-1830
Mailing Address - Street 1:7219 221ST AVE NE
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98053-5927
Mailing Address - Country:US
Mailing Address - Phone:614-371-1830
Mailing Address - Fax:
Practice Address - Street 1:40 LAKE BELLEVUE DR STE 250
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2478
Practice Address - Country:US
Practice Address - Phone:425-209-0700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-13
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Multi-Specialty