Provider Demographics
NPI:1265725691
Name:KOHEIL, YOSRELDIN (DDS)
Entity type:Individual
Prefix:DR
First Name:YOSRELDIN
Middle Name:
Last Name:KOHEIL
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 1:11720 TROPHY CLUB DR
Mailing Address - Street 2:APARTMENT 305-5
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-1463
Mailing Address - Country:US
Mailing Address - Phone:651-280-7471
Mailing Address - Fax:
Practice Address - Street 1:723 S PARK BLVD
Practice Address - Street 2:SUITE F
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-3628
Practice Address - Country:US
Practice Address - Phone:804-504-0012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-18
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014131541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice