Organization
MARK E. KOONMEN, DDS, MS, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK EDWARD KOONMEN DDS (OWNER/PRESIDENT)
(810) 732-0640
Entity
Organization
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
Enumeration date
10/17/2006
Last updated
03/24/2008
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