Provider Demographics
NPI:1083684104
Name:KOAGEL, ANTHONY JOSEPH (DMD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:JOSEPH
Last Name:KOAGEL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:TONY
Other - Middle Name:JOSEPH
Other - Last Name:KOAGEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:1713 WESTON BRENT LN
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79935-3013
Mailing Address - Country:US
Mailing Address - Phone:915-592-2097
Mailing Address - Fax:915-592-2853
Practice Address - Street 1:1713 WESTON BRENT LN
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79935-3013
Practice Address - Country:US
Practice Address - Phone:915-592-2097
Practice Address - Fax:915-592-2853
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000096041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
BK8476194OtherFEDERAL DEA