Provider Demographics
NPI:1053972935
Name:KOOI, DEVON THOMAS (DDS)
Entity type:Individual
Prefix:
First Name:DEVON
Middle Name:THOMAS
Last Name:KOOI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 ABERDEEN DR
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77340-5620
Mailing Address - Country:US
Mailing Address - Phone:936-295-7401
Mailing Address - Fax:
Practice Address - Street 1:2800 ABERDEEN DR
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77340-5620
Practice Address - Country:US
Practice Address - Phone:936-295-7401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-22
Last Update Date:2019-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX353571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice