Healthcare Provider Details

I. General information

NPI: 1184624058
Provider Name (Legal Business Name): DONALD WILLIAM KOHN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 03/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

991 STATE ST
NEW HAVEN CT
06511-3929
US

IV. Provider business mailing address

991 STATE ST
NEW HAVEN CT
06511-3929
US

V. Phone/Fax

Practice location:
  • Phone: 203-787-3669
  • Fax:
Mailing address:
  • Phone: 203-787-3669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number5525
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: