Provider Demographics
NPI:1205036811
Name:KOHUT, DEJAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:DEJAN
Middle Name:
Last Name:KOHUT
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 1:1130 E SONTERRA BLVD
Mailing Address - Street 2:STE. 120
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4235
Mailing Address - Country:US
Mailing Address - Phone:210-497-6677
Mailing Address - Fax:
Practice Address - Street 1:1130 E SONTERRA BLVD
Practice Address - Street 2:STE. 120
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4235
Practice Address - Country:US
Practice Address - Phone:210-497-6677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-21
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX295971223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics