Provider Demographics
NPI:1851507248
Name:KOENIG, WILLIAM (DDS,MSD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:KOENIG
Suffix:
Gender:M
Credentials:DDS,MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2040 HUBBARD RD.
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:OH
Mailing Address - Zip Code:44057
Mailing Address - Country:US
Mailing Address - Phone:440-428-7290
Mailing Address - Fax:
Practice Address - Street 1:2040 HUBBARD RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:OH
Practice Address - Zip Code:44057-2566
Practice Address - Country:US
Practice Address - Phone:440-428-7290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH133021223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics