Provider Demographics
NPI:1184285033
Name:KOEHN, KRICKET LYNN (DDS)
Entity type:Individual
Prefix:DR
First Name:KRICKET
Middle Name:LYNN
Last Name:KOEHN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:922 MARGARET ST
Mailing Address - Street 2:
Mailing Address - City:RHINELANDER
Mailing Address - State:WI
Mailing Address - Zip Code:54501-3923
Mailing Address - Country:US
Mailing Address - Phone:715-365-6859
Mailing Address - Fax:
Practice Address - Street 1:922 MARGARET ST
Practice Address - Street 2:
Practice Address - City:RHINELANDER
Practice Address - State:WI
Practice Address - Zip Code:54501-3923
Practice Address - Country:US
Practice Address - Phone:715-365-6859
Practice Address - Fax:715-362-7060
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-21
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1002131-151223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice