Provider Demographics
NPI:1336229426
Name:KOHL, ROBERT BRADLEY (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:BRADLEY
Last Name:KOHL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:41111 N DAISY MOUNTAIN DR
Mailing Address - Street 2:105
Mailing Address - City:ANTHEM
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-4957
Mailing Address - Country:US
Mailing Address - Phone:623-551-5444
Mailing Address - Fax:623-551-2522
Practice Address - Street 1:41111 N DAISY MOUNTAIN DR
Practice Address - Street 2:105
Practice Address - City:ANTHEM
Practice Address - State:AZ
Practice Address - Zip Code:85086-4957
Practice Address - Country:US
Practice Address - Phone:623-551-5444
Practice Address - Fax:623-551-2522
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ50021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice