Individual
DR. PHILIP LEE KOEHLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
562 MAJESKIE DR, PEWAUKEE, WI 53072-6534
(262) 695-4019
Mailing address
562 MAJESKIE DR, PEWAUKEE, WI 53072
(262) 695-8709
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
4112
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33693000
—
WI
Enumeration date
10/12/2006
Last updated
07/08/2007
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