Provider Demographics
NPI:1861600801
Name:KOENNE, KIRSTEN ANNE (CDA,RDA)
Entity type:Individual
Prefix:MS
First Name:KIRSTEN
Middle Name:ANNE
Last Name:KOENNE
Suffix:
Gender:F
Credentials:CDA,RDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1616 DUNCAN RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-8517
Mailing Address - Country:US
Mailing Address - Phone:865-330-0156
Mailing Address - Fax:865-691-4291
Practice Address - Street 1:323 FOX RD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-3383
Practice Address - Country:US
Practice Address - Phone:865-690-5231
Practice Address - Fax:865-691-4291
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10582126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant