Healthcare Provider Details

I. General information

NPI: 1174592612
Provider Name (Legal Business Name): JOSEPH JOHN KOHLER III DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 07/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

906 WASHINGTON ST
CONNEAUTVILLE PA
16406-7138
US

IV. Provider business mailing address

906 WASHINGTON ST
CONNEAUTVILLE PA
16406-7138
US

V. Phone/Fax

Practice location:
  • Phone: 814-373-2284
  • Fax: 814-587-6579
Mailing address:
  • Phone: 814-373-2284
  • Fax: 814-587-6579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS023124L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: