Provider Demographics
NPI:1750541173
Name:KEVIN KOHLER D.M.D. PC
Entity type:Organization
Organization Name:KEVIN KOHLER D.M.D. PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:LLOYD
Authorized Official - Last Name:KOHLER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:208-376-5499
Mailing Address - Street 1:12426 W EXPLORER DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-1572
Mailing Address - Country:US
Mailing Address - Phone:208-376-5499
Mailing Address - Fax:208-376-5527
Practice Address - Street 1:12426 W EXPLORER DR
Practice Address - Street 2:SUITE 210
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83713-1572
Practice Address - Country:US
Practice Address - Phone:208-376-5499
Practice Address - Fax:208-376-5527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-10
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD36281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty