Provider Demographics
NPI:1942321435
Name:KOELLER, WILLIAM PETER (DMD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:PETER
Last Name:KOELLER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 FRANKLIN AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-2973
Mailing Address - Country:US
Mailing Address - Phone:973-667-3456
Mailing Address - Fax:973-326-9986
Practice Address - Street 1:175 FRANKLIN AVE STE 203
Practice Address - Street 2:
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-2973
Practice Address - Country:US
Practice Address - Phone:973-667-3456
Practice Address - Fax:973-326-9986
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ140451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice