Provider Demographics
NPI:1669636247
Name:KOONTZ, NATALIE SPRING
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:SPRING
Last Name:KOONTZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9405 N PENNSYLVANIA PL
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-3801
Mailing Address - Country:US
Mailing Address - Phone:405-286-9024
Mailing Address - Fax:405-286-9088
Practice Address - Street 1:9405 N PENNSYLVANIA PL
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-3801
Practice Address - Country:US
Practice Address - Phone:405-286-9024
Practice Address - Fax:405-286-9088
Is Sole Proprietor?:No
Enumeration Date:2008-07-14
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6066122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist