Provider Demographics
NPI:1154681385
Name:KOHNEN, STEPHAN ANTONIUS (DMD)
Entity Type:Individual
Prefix:DR
First Name:STEPHAN
Middle Name:ANTONIUS
Last Name:KOHNEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27757 ASPEL RD APT 923
Mailing Address - Street 2:
Mailing Address - City:MENIFEE
Mailing Address - State:CA
Mailing Address - Zip Code:92585-7707
Mailing Address - Country:US
Mailing Address - Phone:832-514-5578
Mailing Address - Fax:
Practice Address - Street 1:27757 ASPEL RD APT 923
Practice Address - Street 2:
Practice Address - City:MENIFEE
Practice Address - State:CA
Practice Address - Zip Code:92585-7707
Practice Address - Country:US
Practice Address - Phone:832-514-5578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-22
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX224711223P0300X
CADDS1074831223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics