Provider Demographics
NPI:1427496389
Name:KOONCE, JENNIFER M (DDS)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:M
Last Name:KOONCE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 E MACARTHUR ST
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74804-2141
Mailing Address - Country:US
Mailing Address - Phone:405-275-4581
Mailing Address - Fax:405-214-4409
Practice Address - Street 1:3 E MACARTHUR ST
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74804-2141
Practice Address - Country:US
Practice Address - Phone:405-275-4581
Practice Address - Fax:405-214-4409
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-12
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK64851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice