Healthcare Provider Details

I. General information

NPI: 1568504660
Provider Name (Legal Business Name): THOMAS MICHAEL KOHLER D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 S 17TH ST
PHILADELPHIA PA
19103-6231
US

IV. Provider business mailing address

255 S 17TH ST
PHILADELPHIA PA
19103-6231
US

V. Phone/Fax

Practice location:
  • Phone: 215-545-5592
  • Fax: 215-545-4559
Mailing address:
  • Phone: 215-545-5592
  • Fax: 215-545-4559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDS019926L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: