Provider Demographics
NPI:1689746232
Name:KOELLING, GEOFFREY CORNELL (DMD)
Entity Type:Individual
Prefix:DR
First Name:GEOFFREY
Middle Name:CORNELL
Last Name:KOELLING
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7170 W CAMINO SAN XAVIER STE C109
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-0862
Mailing Address - Country:US
Mailing Address - Phone:623-282-9959
Mailing Address - Fax:602-429-8200
Practice Address - Street 1:2102 N COUNTRY CLUB RD
Practice Address - Street 2:SUITE A
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-2831
Practice Address - Country:US
Practice Address - Phone:520-323-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC098461223G0001X
AZD050191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice