Provider Demographics
NPI:1043337637
Name:KOLOKOWSKY, DIANA (DDS)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:
Last Name:KOLOKOWSKY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2318 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-1643
Mailing Address - Country:US
Mailing Address - Phone:619-234-6349
Mailing Address - Fax:619-234-7574
Practice Address - Street 1:2318 6TH AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-1643
Practice Address - Country:US
Practice Address - Phone:619-234-6349
Practice Address - Fax:619-234-7574
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA340051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice