Provider Demographics
NPI:1700896859
Name:KOELE, DOUGLAS HEIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:HEIN
Last Name:KOELE
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 1:501 MAIN ST STE 2
Mailing Address - Street 2:
Mailing Address - City:REINBECK
Mailing Address - State:IA
Mailing Address - Zip Code:50669
Mailing Address - Country:US
Mailing Address - Phone:319-345-6667
Mailing Address - Fax:319-345-2449
Practice Address - Street 1:501 MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:REINBECK
Practice Address - State:IA
Practice Address - Zip Code:50669
Practice Address - Country:US
Practice Address - Phone:319-345-6667
Practice Address - Fax:319-345-2449
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06330122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2150771Medicaid