Healthcare Provider Details

I. General information

NPI: 1306770532
Provider Name (Legal Business Name): CHAD B KOHL DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8722 N GARNETT RD
OWASSO OK
74055-4685
US

IV. Provider business mailing address

8722 N GARNETT RD
OWASSO OK
74055-4685
US

V. Phone/Fax

Practice location:
  • Phone: 918-265-1856
  • Fax:
Mailing address:
  • Phone: 918-265-1856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number8255
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: