Healthcare Provider Details

I. General information

NPI: 1467669093
Provider Name (Legal Business Name): RACHEL SHARON KOHL DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5501 OLD YORK RD
PHILADELPHIA PA
19141-3018
US

IV. Provider business mailing address

52 THORNRIDGE DR.
THORNHILL ONTARIO
L4J 1C8
CA

V. Phone/Fax

Practice location:
  • Phone: 215-456-7104
  • Fax:
Mailing address:
  • Phone: 905-731-7117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: