Provider Demographics
NPI:1174499818
Name:JEREMY P. KOONTZ DMD, P.L.L.C.
Entity type:Organization
Organization Name:JEREMY P. KOONTZ DMD, P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:PARCO
Authorized Official - Last Name:KOONTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:360-658-7750
Mailing Address - Street 1:5100 GROVE ST STE B
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98270-4492
Mailing Address - Country:US
Mailing Address - Phone:360-658-7750
Mailing Address - Fax:360-658-1297
Practice Address - Street 1:5100 GROVE ST STE B
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98270-4492
Practice Address - Country:US
Practice Address - Phone:360-658-7750
Practice Address - Fax:360-658-1297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-10
Last Update Date:2025-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty