Provider Demographics
NPI:1740774363
Name:KOESTER, BRIANNE (DDS)
Entity Type:Individual
Prefix:
First Name:BRIANNE
Middle Name:
Last Name:KOESTER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2210 YALE RD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-2647
Mailing Address - Country:US
Mailing Address - Phone:785-312-7770
Mailing Address - Fax:
Practice Address - Street 1:2210 YALE RD
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-2647
Practice Address - Country:US
Practice Address - Phone:785-312-7770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-18
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS61417122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist