Individual
DR. SCOTT KOOISTRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S
Contact information
Practice address
1 PINCKNEY BLVD, BEAUFORT, SC 29902-6122
(843) 228-2683
Mailing address
508 SWITCHGRASS LN, GRAYSLAKE, IL 60030-3522
(847) 752-8360
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12009770A
IN
Other
Enumeration date
01/30/2006
Last updated
08/03/2022
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