Individual
TIMOTHY J KOOB
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
5801 RESEARCH PARK BLVD, STE 110, MADISON, WI 53719-6002
(608) 274-0770
(608) 274-9224
Mailing address
3146 WAUCHEETA TRL, MADISON, WI 53711-5952
(608) 222-8093
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
5109
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12127
DEAN HEALTH PLAN
WI
05
—
33754500
—
WI
Enumeration date
06/18/2006
Last updated
07/09/2007
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