Provider Demographics
NPI:1467461673
Name:RONALD L. KOHLBRAND DDS, PA
Entity Type:Organization
Organization Name:RONALD L. KOHLBRAND DDS, PA
Other - Org Name:KATHLEEN O'CONNOR
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:L
Authorized Official - Last Name:KOHLBRAND
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:321-632-5323
Mailing Address - Street 1:980 SOUTH HWY 1
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955
Mailing Address - Country:US
Mailing Address - Phone:321-632-5323
Mailing Address - Fax:321-632-6834
Practice Address - Street 1:980 SOUTH HWY 1
Practice Address - Street 2:RONALD L. KOHLBRAND DDS PA
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955
Practice Address - Country:US
Practice Address - Phone:321-632-5323
Practice Address - Fax:321-632-6834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN12166122300000X
FLDN13964122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDN12166OtherDENTAL LIC.