Provider Demographics
NPI:1821822172
Name:KOES, BRIANNA NICOLE (DMD)
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:NICOLE
Last Name:KOES
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1328 LACI CT
Mailing Address - Street 2:
Mailing Address - City:INDIAN CREEK
Mailing Address - State:IL
Mailing Address - Zip Code:60061-3279
Mailing Address - Country:US
Mailing Address - Phone:623-687-6330
Mailing Address - Fax:
Practice Address - Street 1:ZACHARY AND ELIZABETH FISHER
Practice Address - Street 2:GREAT LAKES
Practice Address - City:DPO
Practice Address - State:AA
Practice Address - Zip Code:60088
Practice Address - Country:US
Practice Address - Phone:847-688-2469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-29
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD12057122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist