Provider Demographics
NPI:1710871116
Name:KOEHLER, LINDSEY MAYLO (DDS)
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:MAYLO
Last Name:KOEHLER
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 1:10701 XAVIS ST NW
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-4035
Mailing Address - Country:US
Mailing Address - Phone:763-267-8257
Mailing Address - Fax:
Practice Address - Street 1:18230 ZANE ST NW
Practice Address - Street 2:
Practice Address - City:ELK RIVER
Practice Address - State:MN
Practice Address - Zip Code:55330-4501
Practice Address - Country:US
Practice Address - Phone:763-201-1313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-09
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND15288122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist