Provider Demographics
NPI:1932244688
Name:KOEHL, PAUL JAMES (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:JAMES
Last Name:KOEHL
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 1:5541 US HIGHWAY 10 E
Mailing Address - Street 2:SUITE A
Mailing Address - City:STEVENS POINT
Mailing Address - State:WI
Mailing Address - Zip Code:54481-9117
Mailing Address - Country:US
Mailing Address - Phone:715-344-7911
Mailing Address - Fax:715-344-7912
Practice Address - Street 1:5541 US HIGHWAY 10 E
Practice Address - Street 2:SUITE A
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54481-9117
Practice Address - Country:US
Practice Address - Phone:715-344-7911
Practice Address - Fax:715-344-7912
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI35991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33680900Medicaid