Provider Demographics
NPI:1154854453
Name:KOLLANDER, EVAN JUDAH (DDS)
Entity Type:Individual
Prefix:DR
First Name:EVAN
Middle Name:JUDAH
Last Name:KOLLANDER
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 1:525 E 68TH ST # F-2132
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-4870
Mailing Address - Country:US
Mailing Address - Phone:516-902-3537
Mailing Address - Fax:
Practice Address - Street 1:800 OCEAN PKWY STE AA
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-2124
Practice Address - Country:US
Practice Address - Phone:718-633-4963
Practice Address - Fax:718-435-8916
Is Sole Proprietor?:No
Enumeration Date:2017-04-04
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY059995122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist