Provider Demographics
NPI:1952312126
Name:KOHRT, ROBERT W III (DDS)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:W
Last Name:KOHRT
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:ROBERT
Other - Middle Name:
Other - Last Name:KOHRT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:472-355 DEBI DR
Mailing Address - Street 2:
Mailing Address - City:SUSANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:96130-5972
Mailing Address - Country:US
Mailing Address - Phone:530-310-1500
Mailing Address - Fax:530-257-0788
Practice Address - Street 1:151 ASH ST
Practice Address - Street 2:SUITE B
Practice Address - City:SUSANVILLE
Practice Address - State:CA
Practice Address - Zip Code:96130-4539
Practice Address - Country:US
Practice Address - Phone:530-257-2828
Practice Address - Fax:530-257-0788
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33608122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist