Provider Demographics
NPI:1912742008
Name:KOERNER, JOSHUA (DMD)
Entity type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:
Last Name:KOERNER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2535 GALEN DR
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61821-7005
Mailing Address - Country:US
Mailing Address - Phone:217-356-7334
Mailing Address - Fax:
Practice Address - Street 1:2535 GALEN DR
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61821-7005
Practice Address - Country:US
Practice Address - Phone:217-356-7334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-28
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019035177122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist