Provider Demographics
NPI:1801309265
Name:KOENIGSKNECHT DENTISTRY PLLC
Entity type:Organization
Organization Name:KOENIGSKNECHT DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KOENIGSKNECHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-224-2319
Mailing Address - Street 1:102 E CASS ST
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:MI
Mailing Address - Zip Code:48879-1833
Mailing Address - Country:US
Mailing Address - Phone:989-224-2319
Mailing Address - Fax:989-224-2144
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:989-224-2144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-08
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010204051223G0001X
MI29010191121223G0001X
MI29010118261223G0001X
1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty