Provider Demographics
NPI:1134567746
Name:KOISTINEN, LAMAR WILBUR (DDS)
Entity type:Individual
Prefix:
First Name:LAMAR
Middle Name:WILBUR
Last Name:KOISTINEN
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 1:401 PRAIRIE AVE SW
Mailing Address - Street 2:PO BOX 49
Mailing Address - City:DESMET
Mailing Address - State:SD
Mailing Address - Zip Code:57231
Mailing Address - Country:US
Mailing Address - Phone:605-854-3455
Mailing Address - Fax:605-854-9952
Practice Address - Street 1:401 PRAIRIE AVE SW
Practice Address - Street 2:
Practice Address - City:DESMET
Practice Address - State:SD
Practice Address - Zip Code:57231
Practice Address - Country:US
Practice Address - Phone:605-854-3455
Practice Address - Fax:605-854-9952
Is Sole Proprietor?:No
Enumeration Date:2013-06-06
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD413122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist