Healthcare Provider Details

I. General information

NPI: 1104913581
Provider Name (Legal Business Name): KRISTIN K KOHLER D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 08/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 S 70TH ST SUITE 200
LINCOLN NE
68506-1570
US

IV. Provider business mailing address

5410 S 88TH ST
LINCOLN NE
68526-9560
US

V. Phone/Fax

Practice location:
  • Phone: 402-488-8140
  • Fax:
Mailing address:
  • Phone: 402-488-8140
  • Fax: 408-488-8170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number6134
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: