Provider Demographics
NPI:1255693396
Name:KOLKMAN, MATTHEW S (DDS)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:S
Last Name:KOLKMAN
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 1:10321 GARMAN RD
Mailing Address - Street 2:
Mailing Address - City:LEO
Mailing Address - State:IN
Mailing Address - Zip Code:46765-9798
Mailing Address - Country:US
Mailing Address - Phone:260-241-4031
Mailing Address - Fax:
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:260-627-1121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-14
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011830A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist