Provider Demographics
NPI:1013021526
Name:KOLPIN, RODNEY A (DDS)
Entity Type:Individual
Prefix:
First Name:RODNEY
Middle Name:A
Last Name:KOLPIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1504 4TH ST NE
Mailing Address - Street 2:
Mailing Address - City:WASECA
Mailing Address - State:MN
Mailing Address - Zip Code:56093-2721
Mailing Address - Country:US
Mailing Address - Phone:507-835-1080
Mailing Address - Fax:507-835-1184
Practice Address - Street 1:1504 4TH ST NE
Practice Address - Street 2:
Practice Address - City:WASECA
Practice Address - State:MN
Practice Address - Zip Code:56093-2721
Practice Address - Country:US
Practice Address - Phone:507-835-1080
Practice Address - Fax:507-835-1184
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN85371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice