Provider Demographics
NPI:1134136203
Name:KOLPON, SCOTT (DDS)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:
Last Name:KOLPON
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 1:2611 E 13TH ST
Mailing Address - Street 2:SUITE 1H
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-4449
Mailing Address - Country:US
Mailing Address - Phone:718-743-2264
Mailing Address - Fax:
Practice Address - Street 1:2611 E 13TH ST
Practice Address - Street 2:SUITE 1H
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-4449
Practice Address - Country:US
Practice Address - Phone:718-743-2264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033026122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist