Provider Demographics
NPI:1922263086
Name:COONEN, MARTIN K (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:K
Last Name:COONEN
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 1:64 MEDICAL PARK DR STE 1
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-4903
Mailing Address - Country:US
Mailing Address - Phone:406-442-3191
Mailing Address - Fax:406-449-9957
Practice Address - Street 1:64 MEDICAL PARK DR STE 1
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-4903
Practice Address - Country:US
Practice Address - Phone:406-442-3190
Practice Address - Fax:406-449-9957
Is Sole Proprietor?:No
Enumeration Date:2008-07-28
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT23131223D0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223D0001XDental ProvidersDentistDental Public Health