Provider Demographics
NPI:1265420855
Name:KOHAN, KONSTANTIN JOHN (DDS)
Entity type:Individual
Prefix:DR
First Name:KONSTANTIN
Middle Name:JOHN
Last Name:KOHAN
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 1:304 E RAND RD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-3190
Mailing Address - Country:US
Mailing Address - Phone:847-255-3227
Mailing Address - Fax:847-255-3814
Practice Address - Street 1:304 E RAND RD
Practice Address - Street 2:SUITE 240
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-3182
Practice Address - Country:US
Practice Address - Phone:847-255-3227
Practice Address - Fax:847-255-3814
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice