Provider Demographics
NPI:1821424185
Name:KOEHLER, JAMES L JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:L
Last Name:KOEHLER
Suffix:JR
Gender:M
Credentials:DMD
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Mailing Address - Street 1:4323 HILL STREET
Mailing Address - Street 2:US ARMY DENTAL ACTIVITY
Mailing Address - City:FORT JACKSON
Mailing Address - State:SC
Mailing Address - Zip Code:29207-6022
Mailing Address - Country:US
Mailing Address - Phone:803-751-6213
Mailing Address - Fax:803-751-6886
Practice Address - Street 1:BLD B-6837 NORMANDY DRIVE
Practice Address - Street 2:US ARMY DENTAL ACTIVITY
Practice Address - City:FORT BRAGG
Practice Address - State:NC
Practice Address - Zip Code:28301-6022
Practice Address - Country:US
Practice Address - Phone:617-780-6125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-18
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT87053111223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty