Provider Demographics
NPI:1457572836
Name:KOHLI, SUTINDER SINGH (BDS,MS,FAGD)
Entity type:Individual
Prefix:DR
First Name:SUTINDER
Middle Name:SINGH
Last Name:KOHLI
Suffix:
Gender:M
Credentials:BDS,MS,FAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2075 S PALMETTO AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH DAYTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32119-2224
Mailing Address - Country:US
Mailing Address - Phone:386-756-7901
Mailing Address - Fax:386-872-7532
Practice Address - Street 1:464 S RIDGEWOOD AVE
Practice Address - Street 2:SUITE#1
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-4928
Practice Address - Country:US
Practice Address - Phone:386-255-8866
Practice Address - Fax:386-872-7532
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2014-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN131071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice