Provider Demographics
NPI:1215157540
Name:KOYL, JONATHAN ALLEN (DDS)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:ALLEN
Last Name:KOYL
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 1:528 W CHICAGO ST
Mailing Address - Street 2:APARTMENT #12
Mailing Address - City:COLDWATER
Mailing Address - State:MI
Mailing Address - Zip Code:49036-8411
Mailing Address - Country:US
Mailing Address - Phone:517-278-0503
Mailing Address - Fax:
Practice Address - Street 1:575 NORTH UNION CITY ROAD
Practice Address - Street 2:
Practice Address - City:COLDWATER
Practice Address - State:MI
Practice Address - Zip Code:49036
Practice Address - Country:US
Practice Address - Phone:517-279-9212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010193301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice