Provider Demographics
NPI:1114293099
Name:KOEN, LLOYD D (DDS)
Entity type:Individual
Prefix:DR
First Name:LLOYD
Middle Name:D
Last Name:KOEN
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 1:2500 COULTER RD.
Mailing Address - Street 2:SUITE 101
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-2631
Mailing Address - Country:US
Mailing Address - Phone:806-358-8561
Mailing Address - Fax:806-358-3646
Practice Address - Street 1:2500 COULTER RD.
Practice Address - Street 2:SUITE 101
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-2631
Practice Address - Country:US
Practice Address - Phone:806-358-8561
Practice Address - Fax:806-358-3646
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-26
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10969122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist