Provider Demographics
NPI:1316935216
Name:KOHLMANN, IRIS MARIA (DDS, MSD)
Entity type:Individual
Prefix:DR
First Name:IRIS
Middle Name:MARIA
Last Name:KOHLMANN
Suffix:
Gender:F
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10820 COMANCHE RD NE
Mailing Address - Street 2:SUITE A
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-3983
Mailing Address - Country:US
Mailing Address - Phone:505-296-0761
Mailing Address - Fax:505-296-7543
Practice Address - Street 1:10820 COMANCHE RD NE
Practice Address - Street 2:SUITE A
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-3983
Practice Address - Country:US
Practice Address - Phone:505-296-0761
Practice Address - Fax:505-296-7543
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD24141223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM9177623Medicaid