Active NPI
Mark Edward Koonmen, DDS
- Pediatric Dentistry
- Flint, MI
National Provider Identifier
1326028044
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 13770
- Practice address
- 1122 S Linden Rd
Flint, MI 48532-3437 - Phone
- (810) 732-0640
- Fax
- (810) 732-2264
- NPI assigned
- Jan 19, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 13770 | MI | Primary |
Addresses
Primary practice location
1122 S Linden Rd
Flint, MI 48532-3437
Mailing address
1122 S Linden Rd
Flint, MI 48532-3437
Phone (810) 732-0640
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| J801645 | Other | MI | BLUE CROSS AND BLUE SHIEL |
| 1831730 | Medicaid | MI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13770 | MI | MD | Pediatric Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mark E. Koonmen, DDS, Ms, PC | Pediatric Dentistry | Past | Accepting new patients |
| Terence Chan, DDS, MSD, PC | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Pediatric Dentistry
- Flint, MI
- NPI 1396825998
-
- Dental Clinic/Center
- Flint, MI
- NPI 1225280712
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1137628800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1326028044",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1122 S LINDEN RD",
"city": "FLINT",
"state": "MI",
"postal_code": "485323437",
"telephone_number": "810-732-0640",
"fax_number": "810-732-2264"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1122 S LINDEN RD",
"city": "FLINT",
"state": "MI",
"postal_code": "485323437",
"telephone_number": "810-732-0640",
"fax_number": "810-732-2264"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOONMEN",
"first_name": "MARK",
"middle_name": "EDWARD",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-01-19",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "MI",
"license": "13770",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS AND BLUE SHIEL",
"identifier": "J801645",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1831730",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Flint, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.