Provider Demographics
NPI:1154848158
Name:KOLI, KOMAL (DDS)
Entity Type:Individual
Prefix:DR
First Name:KOMAL
Middle Name:
Last Name:KOLI
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 1:8 NORDEN PL APT 439
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06855-1483
Mailing Address - Country:US
Mailing Address - Phone:706-631-0051
Mailing Address - Fax:
Practice Address - Street 1:105 MYRTLE ST
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06051-1859
Practice Address - Country:US
Practice Address - Phone:860-356-4675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-29
Last Update Date:2017-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT118831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice