MEDICARE: JOHNATHAN KOHLES DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	18639	MD

General Provider Information

NPI Number	:	1659260305
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHNATHAN KOHLES DDS

Provider Business Mailing Address
First Line	:	18745 BETHPAGE DR
Second Line	:
City	:	LEWES
State	:	DE
Zip	:	19958-4859
Country	:	US
Telephone Number	:	443-987-0941
Fax Number	:

Provider Business Practice Location Address
First Line	:	2280 HOGAN ST
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80913-4408
Country	:	US
Telephone Number	:	719-526-5400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2025
Last Update Date	:	06/30/2025

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