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General NPI Number Information
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NPI Number | 1457572836
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Entity Type | Individual
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Provider Name | SUTINDER SINGH KOHLI BDS,MS,FAGD
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Gender | Male
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Dates
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Enumeration Date | 05/01/2007
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Last Update Date | 11/01/2014
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Provider Practice Location Address
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Address Line | 464 S RIDGEWOOD AVE SUITE#1
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City | DAYTONA BEACH
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State | FL
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Zip | 32114-4928
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Country | US
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Telephone | 386-255-8866
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Fax | 386-872-7532
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Provider Business Mailing Address
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Address Line | 2075 S PALMETTO AVE
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City | SOUTH DAYTONA
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State | FL
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Zip | 32119-2224
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Country | US
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Telephone | 386-756-7901
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Fax | 386-872-7532
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN13107
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License Number State | FL
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