Provider Demographics
NPI:1184722084
Name:KOHLSAAT, PETER WILLIAM (DDS)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:WILLIAM
Last Name:KOHLSAAT
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 1:5536 RICHMOND CURV
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55410-2534
Mailing Address - Country:US
Mailing Address - Phone:612-920-0464
Mailing Address - Fax:
Practice Address - Street 1:2121 CLIFF DR
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-3335
Practice Address - Country:US
Practice Address - Phone:651-452-4828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND85431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice