Individual
DR. JEFFREY HOWARD KOOTMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
702 E BELL RD, B103, PHOENIX, AZ 85022
(602) 493-1140
(602) 493-5328
Mailing address
702 E BELL RD, B103, PHOENIX, AZ 85022
(602) 493-1140
(602) 493-5328
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
3369
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
093229
—
AZ
Enumeration date
12/26/2006
Last updated
07/08/2007
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