Provider Demographics
NPI:1336315274
Name:KOHN, RICHARD ALAN (DDS MS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ALAN
Last Name:KOHN
Suffix:
Gender:M
Credentials:DDS MS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:475 W 55TH ST
Mailing Address - Street 2:SUITE 208
Mailing Address - City:COUNTRYSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-3564
Mailing Address - Country:US
Mailing Address - Phone:708-579-0488
Mailing Address - Fax:708-579-0611
Practice Address - Street 1:475 W 55TH ST
Practice Address - Street 2:SUITE 208
Practice Address - City:COUNTRYSIDE
Practice Address - State:IL
Practice Address - Zip Code:60525-3564
Practice Address - Country:US
Practice Address - Phone:708-579-0488
Practice Address - Fax:708-579-0611
Is Sole Proprietor?:No
Enumeration Date:2008-04-30
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL021-0011061223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics