Provider Demographics
NPI:1750509212
Name:KOHN, RANDY L (DDS)
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:L
Last Name:KOHN
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 1:34121 23 MILE RD
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48047-2077
Mailing Address - Country:US
Mailing Address - Phone:586-725-2125
Mailing Address - Fax:586-725-2125
Practice Address - Street 1:34121 23 MILE RD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MI
Practice Address - Zip Code:48047-2077
Practice Address - Country:US
Practice Address - Phone:586-725-2125
Practice Address - Fax:586-725-2125
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI015614122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist