Provider Demographics
NPI:1306611181
Name:DONALD A. KOONTZ DDS PLLC
Entity type:Organization
Organization Name:DONALD A. KOONTZ DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:A
Authorized Official - Last Name:KOONTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:425-745-3766
Mailing Address - Street 1:12812 3RD AVE SE STE B
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-6455
Mailing Address - Country:US
Mailing Address - Phone:425-745-3766
Mailing Address - Fax:
Practice Address - Street 1:12812 3RD AVE SE STE B
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-6455
Practice Address - Country:US
Practice Address - Phone:425-745-3766
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-21
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental