Individual
DR. RALPH ANDREW KOOISTRA JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
3096 WEST M-32 HWY, GAYLORD, MI 49735
(989) 731-2087
Mailing address
795 NAGASHI DR, EAST JORDAN, MI 49727-9492
(231) 536-3032
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
16224
MI
Other
Enumeration date
02/21/2007
Last updated
07/08/2007
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