Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 3521 | KY |
N | 1223P0300X | Periodontist | 152 | KY |
NPI | 1093826208 |
---|---|
Provider Name | Dr. Howard Burton O Koon |
First Address | Louisville, KY 40207 |
Second Address | Louisville, KY 40207 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 08/07/2007 |