Provider Demographics
NPI:1710299094
Name:KOO, BONHEE REBECCA (DMD)
Entity Type:Individual
Prefix:
First Name:BONHEE
Middle Name:REBECCA
Last Name:KOO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2142 N COLLINS ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76011-2877
Mailing Address - Country:US
Mailing Address - Phone:682-560-4486
Mailing Address - Fax:
Practice Address - Street 1:2142 N COLLINS ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011-2877
Practice Address - Country:US
Practice Address - Phone:682-560-4486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-02
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX28703122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist