Provider Demographics
NPI:1093151474
Name:KOHLBRAND, RONALD (DDS)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:
Last Name:KOHLBRAND
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 1:980 HIGHWAY 1
Mailing Address - Street 2:RONALD KOHLBRAND DDS
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-2128
Mailing Address - Country:US
Mailing Address - Phone:321-632-5323
Mailing Address - Fax:321-632-6834
Practice Address - Street 1:980 HIGHWAY 1
Practice Address - Street 2:RONALD KOHLBRAND DDS
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-2128
Practice Address - Country:US
Practice Address - Phone:321-632-5323
Practice Address - Fax:321-632-6834
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-13
Last Update Date:2017-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN12166122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDN12166OtherDENTAL LICENSE