Individual
DR. DOUGLAS WILLIAM KOENKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
42850 SCHOENHERR RD, SUITE 5, STERLING HEIGHTS, MI 48313-2875
(586) 566-0088
(586) 566-0568
Mailing address
42850 SCHOENHERR RD, SUITE 5, STERLING HEIGHTS, MI 48313-2875
(586) 566-0088
(586) 566-0568
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
13000
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13000
DENTAL LICENSE
MI
Enumeration date
01/03/2006
Last updated
07/08/2007
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