Provider Demographics
NPI:1841357936
Name:KOHLS, SUSAN M
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:M
Last Name:KOHLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3606 S REGAL ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99223-4648
Mailing Address - Country:US
Mailing Address - Phone:509-534-0428
Mailing Address - Fax:
Practice Address - Street 1:3606 S REGAL AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99223-4648
Practice Address - Country:US
Practice Address - Phone:509-534-0428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA71521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice