Individual
JUSTIN THOMAS KOONTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
113 W ARBOR LN, EDEN, NC 27288-5305
(336) 623-9143
Mailing address
113 W ARBOR LN, EDEN, NC 27288-5305
(336) 623-9143
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
13850
NC
Other
Enumeration date
07/22/2024
Last updated
07/22/2024
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