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Individual
MR. JUSTIN DEXTER KOEN
Active
Individual
MR. JUSTIN DEXTER KOEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
21429
MA
1223G0001X
General Practice Dentistry
Primary
23961
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100708
DELTA DENTAL
MA
01
—
K10973
BC BS OF MA
MA
Enumeration date
11/01/2006
Last updated
03/01/2021
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