Richard John Koeltl Jr., D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

47745 Issued in CA

Practice address

4165 Blackhawk Plaza Cir
Suite 200
Danville, CA 94506-4904

Phone

(925) 736-4201

Fax

(925) 736-2107

NPI assigned

Jun 20, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1182297600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1346445152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4165 BLACKHAWK PLAZA CIR",
            "address_2": "SUITE 200",
            "city": "DANVILLE",
            "state": "CA",
            "postal_code": "945064904",
            "telephone_number": "925-736-4201",
            "fax_number": "925-736-2107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4165 BLACKHAWK PLAZA CIR",
            "address_2": "SUITE 200",
            "city": "DANVILLE",
            "state": "CA",
            "postal_code": "945064904",
            "telephone_number": "925-736-4201",
            "fax_number": "925-736-2107"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOELTL",
        "first_name": "RICHARD",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-06-20",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "47745",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brittany Bayles Klinger, LMFT
• Nikos Klironomos
• James Yoshitatsu Kobayashi, D.D.S.
• Kobsar Chiropractic Corp
• Melanie Apostle Koehler, DDS
• Mark Richard Koenen, DDS
• Carrie Kojima
• Michelle Nicole Kolander
• Matthew Aaron Kolej
• Yana Kononovich, LCSW

• General Practice Dentistry in Danville, CA
• Providers in Danville, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.