Provider Demographics
NPI:1700081171
Name:KOENIGSKNECHT, NICHOLAS RALPH (DDS)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:RALPH
Last Name:KOENIGSKNECHT
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 1:1307 KELCRASTA DR
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:MI
Mailing Address - Zip Code:48879-8263
Mailing Address - Country:US
Mailing Address - Phone:989-224-1872
Mailing Address - Fax:
Practice Address - Street 1:102 E CASS ST
Practice Address - Street 2:
Practice Address - City:SAINT JOHNS
Practice Address - State:MI
Practice Address - Zip Code:48879-1833
Practice Address - Country:US
Practice Address - Phone:989-224-2319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010191121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice