Provider Demographics
NPI:1831312321
Name:KOOI, PAUL GREGORY (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:GREGORY
Last Name:KOOI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 ABERDEEN DR
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77340-5620
Mailing Address - Country:US
Mailing Address - Phone:936-295-7401
Mailing Address - Fax:936-295-6142
Practice Address - Street 1:2800 ABERDEEN DR
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77340-5620
Practice Address - Country:US
Practice Address - Phone:936-295-7401
Practice Address - Fax:936-295-6142
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX139061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice