Provider Demographics
NPI:1144686718
Name:KOOT, JOHN HENRY (DMD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:HENRY
Last Name:KOOT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2315 E TROPICANA AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-6543
Mailing Address - Country:US
Mailing Address - Phone:702-736-6381
Mailing Address - Fax:702-736-9420
Practice Address - Street 1:2315 E TROPICANA AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-6543
Practice Address - Country:US
Practice Address - Phone:702-736-6381
Practice Address - Fax:702-736-9420
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-12
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV619122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist