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Individual

DR. GARY LIONEL KOEHL

Active
Sole proprietor

Provider details

NPI number
Gender
Man
Credential
DDS

Contact information

Practice address
1015 SHOOK AVE, SAN ANTONIO, TX 78212-2508
(210) 826-2373
(210) 826-2374
Mailing address
1015 SHOOK AVE, SAN ANTONIO, TX 78212-2508
(210) 826-2373
(210) 826-2374

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D10371
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
527724
UNITED CONCORDIA
01
BK04
BCBS
TX
Enumeration date
09/27/2005
Last updated
07/08/2007
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