Provider Demographics
NPI:1629098702
Name:KOEHLER, STEVEN JAY (DMD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:JAY
Last Name:KOEHLER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4745 BOARDWALK DR
Mailing Address - Street 2:SUITE D102
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80527
Mailing Address - Country:US
Mailing Address - Phone:970-223-6101
Mailing Address - Fax:970-530-1593
Practice Address - Street 1:4745 BOARDWALK DR
Practice Address - Street 2:SUITE D102
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-3768
Practice Address - Country:US
Practice Address - Phone:970-223-6101
Practice Address - Fax:970-530-1593
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7204122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist