Provider Demographics
NPI:1639386501
Name:T KOEN ORTHODONTICS PLLC
Entity Type:Organization
Organization Name:T KOEN ORTHODONTICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TOMMY
Authorized Official - Middle Name:J
Authorized Official - Last Name:KOEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:615-824-5636
Mailing Address - Street 1:131 INDIAN LAKE BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-6210
Mailing Address - Country:US
Mailing Address - Phone:615-824-5636
Mailing Address - Fax:615-824-5707
Practice Address - Street 1:131 INDIAN LAKE BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-6210
Practice Address - Country:US
Practice Address - Phone:615-824-5636
Practice Address - Fax:615-824-5707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN41131223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty