Provider Demographics
NPI:1356452023
Name:KOHLHORST, JUSTIN R (DDS)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:R
Last Name:KOHLHORST
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 1:2508 CASEYS DR
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67846-3314
Mailing Address - Country:US
Mailing Address - Phone:620-275-1878
Mailing Address - Fax:620-275-2872
Practice Address - Street 1:2508 CASEYS DR
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:KS
Practice Address - Zip Code:67846-3314
Practice Address - Country:US
Practice Address - Phone:620-275-1878
Practice Address - Fax:620-275-2872
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS65161223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics