Provider Demographics
NPI:1871671313
Name:JOHN H. KOOT, D.M.D., LTD.
Entity Type:Organization
Organization Name:JOHN H. KOOT, D.M.D., LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:KOOT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:702-736-6381
Mailing Address - Street 1:2315 E TROPICANA AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-6543
Mailing Address - Country:US
Mailing Address - Phone:702-736-6381
Mailing Address - Fax:702-736-9420
Practice Address - Street 1:2315 E TROPICANA AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-6543
Practice Address - Country:US
Practice Address - Phone:702-736-6381
Practice Address - Fax:702-736-9420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV619122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty