Provider Demographics
NPI:1164786133
Name:MKD DENTAL GROUP
Entity Type:Organization
Organization Name:MKD DENTAL GROUP
Other - Org Name:GRABILL FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:KOLKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:260-627-1211
Mailing Address - Street 1:13307 WITMER RD
Mailing Address - Street 2:
Mailing Address - City:GRABILL
Mailing Address - State:IN
Mailing Address - Zip Code:46741-9636
Mailing Address - Country:US
Mailing Address - Phone:260-627-1211
Mailing Address - Fax:260-627-1277
Practice Address - Street 1:13307 WITMER RD
Practice Address - Street 2:
Practice Address - City:GRABILL
Practice Address - State:IN
Practice Address - Zip Code:46741-9636
Practice Address - Country:US
Practice Address - Phone:260-627-1211
Practice Address - Fax:260-627-1277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-25
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty