# JEREMY P. KOONTZ DMD, P.L.L.C.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Northwest Smile Design
- **Organization subpart:** No

## Provider details

- **NPI number:** 1174499818
- **Authorized official:** DR. JEREMY PARCO KOONTZ DMD (OWNER)
- **Authorized official phone:** (360) 658-7750

## Contact information

- **Practice address:** 5100 GROVE ST STE B, MARYSVILLE, WA 98270-4492
- **Practice address phone:** (360) 658-7750
- **Practice address fax:** (360) 658-1297
- **Mailing address:** 5100 GROVE ST STE B, MARYSVILLE, WA 98270-4492
- **Mailing address phone:** (360) 658-7750
- **Mailing address fax:** (360) 658-1297

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | NULL | Yes |
| 122300000X | Dentist | — | — | Yes |

## Other

- **Enumeration date:** 10/10/2025
- **Last updated:** 10/10/2025