Provider Demographics
NPI:1073641882
Name:KOLB, BRENT ALAN (DDS)
Entity Type:Individual
Prefix:
First Name:BRENT
Middle Name:ALAN
Last Name:KOLB
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 1:1695 NORTHBROOK DR
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-6194
Mailing Address - Country:US
Mailing Address - Phone:734-426-9000
Mailing Address - Fax:734-426-8845
Practice Address - Street 1:8031 MAIN STREET
Practice Address - Street 2:SUITE 303
Practice Address - City:DEXTER
Practice Address - State:MI
Practice Address - Zip Code:48130-1150
Practice Address - Country:US
Practice Address - Phone:734-426-9000
Practice Address - Fax:734-426-8845
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010187841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice