Provider Demographics
NPI:1821113564
Name:KOEN, MARY CAY (DDS MS)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:CAY
Last Name:KOEN
Suffix:
Gender:F
Credentials:DDS MS
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Mailing Address - Street 1:2020 CALDWELL DRIVE
Mailing Address - Street 2:
Mailing Address - City:GOODSLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-3579
Mailing Address - Country:US
Mailing Address - Phone:615-851-1222
Mailing Address - Fax:615-851-9837
Practice Address - Street 1:2020 CALDWELL DRIVE
Practice Address - Street 2:
Practice Address - City:GOODSLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072-3579
Practice Address - Country:US
Practice Address - Phone:615-851-1222
Practice Address - Fax:615-851-9837
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNTN37791223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics