1952312126 NPI number — ROBERT W. KOHRT III D.D.S.

Table of content: ROBERT W. KOHRT III D.D.S. (NPI 1952312126)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952312126 NPI number — ROBERT W. KOHRT III D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOHRT
Provider First Name:
ROBERT
Provider Middle Name:
W.
Provider Name Prefix Text:
Provider Name Suffix Text:
III
Provider Credential Text:
D.D.S.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KOHRT
Provider Other First Name:
ROBERT
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.D.S.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1952312126
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
472-355 DEBI DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUSANVILLE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
96130-5972
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-310-1500
Provider Business Mailing Address Fax Number:
530-257-0788

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
151 ASH ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
SUSANVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96130-4539
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-257-2828
Provider Business Practice Location Address Fax Number:
530-257-0788
Provider Enumeration Date:
08/11/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  33608 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)