Provider Demographics
NPI:1598504458
Name:KOEHN, DYLAN WESLEY (DDS)
Entity type:Individual
Prefix:DR
First Name:DYLAN
Middle Name:WESLEY
Last Name:KOEHN
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 1:3308 NW 42ND ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-6228
Mailing Address - Country:US
Mailing Address - Phone:580-461-0142
Mailing Address - Fax:
Practice Address - Street 1:1024 N MAIN ST
Practice Address - Street 2:
Practice Address - City:GUYMON
Practice Address - State:OK
Practice Address - Zip Code:73942-3612
Practice Address - Country:US
Practice Address - Phone:580-330-0072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-21
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK78461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice