Provider Demographics
NPI:1942386099
Name:KARL & SARA KOELLING DDS, P.C.
Entity Type:Organization
Organization Name:KARL & SARA KOELLING DDS, P.C.
Other - Org Name:KINGSLEY DENTAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KARL
Authorized Official - Middle Name:DUANE
Authorized Official - Last Name:KOELLING
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:712-378-2061
Mailing Address - Street 1:12 EAST 2ND
Mailing Address - Street 2:
Mailing Address - City:KINGSLEY
Mailing Address - State:IA
Mailing Address - Zip Code:51028-0220
Mailing Address - Country:US
Mailing Address - Phone:712-378-2061
Mailing Address - Fax:712-378-2348
Practice Address - Street 1:12 EAST 2ND
Practice Address - Street 2:
Practice Address - City:KINGSLEY
Practice Address - State:IA
Practice Address - Zip Code:51028-0220
Practice Address - Country:US
Practice Address - Phone:712-378-2061
Practice Address - Fax:712-378-2348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA079971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty