Provider Demographics
NPI:1487947560
Name:KOENIGSKNECHT, JONATHAN JAMES (DDS)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:JAMES
Last Name:KOENIGSKNECHT
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 1:102 E CASS ST
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:MI
Mailing Address - Zip Code:48879-1833
Mailing Address - Country:US
Mailing Address - Phone:989-224-2319
Mailing Address - Fax:989-224-2144
Practice Address - Street 1:102 E CASS ST
Practice Address - Street 2:
Practice Address - City:SAINT JOHNS
Practice Address - State:MI
Practice Address - Zip Code:48879-1833
Practice Address - Country:US
Practice Address - Phone:989-224-2319
Practice Address - Fax:989-224-2144
Is Sole Proprietor?:No
Enumeration Date:2011-05-23
Last Update Date:2011-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010204051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice