Provider Demographics
NPI:1750536306
Name:KOEHLER, JOEL S (DDS)
Entity type:Individual
Prefix:DR
First Name:JOEL
Middle Name:S
Last Name:KOEHLER
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 1:3560 DELAWARE ST
Mailing Address - Street 2:SUITE 604
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-3067
Mailing Address - Country:US
Mailing Address - Phone:409-898-7218
Mailing Address - Fax:
Practice Address - Street 1:3560 DELAWARE ST
Practice Address - Street 2:SUITE 604
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-3067
Practice Address - Country:US
Practice Address - Phone:409-898-7218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-24
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice