Individual
DR. MARK EDWARD KOONMEN
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1122 S LINDEN RD, FLINT, MI 48532-3437
(810) 732-0640
(810) 732-2264
Mailing address
1122 S LINDEN RD, FLINT, MI 48532-3437
(810) 732-0640
(810) 732-2264
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
13770
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1831730
—
MI
01
—
J801645
BLUE CROSS AND BLUE SHIEL
MI
Enumeration date
01/19/2006
Last updated
07/08/2007
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