Provider Demographics
NPI:1205939675
Name:KOONS, JOHN D (DMD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:D
Last Name:KOONS
Suffix:
Gender:M
Credentials:DMD
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Mailing Address - Street 1:2 QUEENS WAY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901
Mailing Address - Country:US
Mailing Address - Phone:207-872-5252
Mailing Address - Fax:207-872-7789
Practice Address - Street 1:2 QUEENS WAY
Practice Address - Street 2:SUITE 1
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901
Practice Address - Country:US
Practice Address - Phone:207-872-5252
Practice Address - Fax:207-872-7789
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ME010362317 ME25811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice