Provider Demographics
NPI:1669161956
Name:KOESTER, EMILY ROSE (DMD)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:ROSE
Last Name:KOESTER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3790 N FORDNEY RD
Mailing Address - Street 2:
Mailing Address - City:HEMLOCK
Mailing Address - State:MI
Mailing Address - Zip Code:48626-8475
Mailing Address - Country:US
Mailing Address - Phone:989-327-8012
Mailing Address - Fax:
Practice Address - Street 1:4196 STATE ST
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-4025
Practice Address - Country:US
Practice Address - Phone:989-799-5850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-03
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901601838122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist