Provider Demographics
NPI:1710083324
Name:KOIS, JOHN CONSTANTINE (DMD, MSD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CONSTANTINE
Last Name:KOIS
Suffix:
Gender:M
Credentials:DMD, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5615 VALLEY AVE E
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98424-2060
Mailing Address - Country:US
Mailing Address - Phone:253-922-6056
Mailing Address - Fax:253-922-3517
Practice Address - Street 1:5615 VALLEY AVE E
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98424-2060
Practice Address - Country:US
Practice Address - Phone:253-922-6056
Practice Address - Fax:253-922-3517
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000057991223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics