Individual
DONALD A KOONTZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
12806 3RD AVE SE, EVERETT, WA 98208-6455
(425) 338-0666
(425) 337-6570
Mailing address
16518 39TH AVE NE, LAKE FOREST PARK, WA 98155-5602
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
6865
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6865
ST. DENTAL LICENSE #
WA
Enumeration date
10/05/2006
Last updated
07/08/2007
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