Provider Demographics
NPI:1326395252
Name:KOLARE JEFFREY, SUSANNE MARIA ELISABETH (DDS, PHD)
Entity Type:Individual
Prefix:DR
First Name:SUSANNE
Middle Name:MARIA ELISABETH
Last Name:KOLARE JEFFREY
Suffix:
Gender:F
Credentials:DDS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1959 NE PACIFIC ST
Mailing Address - Street 2:BOX 357131
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98195-7131
Mailing Address - Country:US
Mailing Address - Phone:206-221-0236
Mailing Address - Fax:206-616-9520
Practice Address - Street 1:1959 NE PACIFIC ST
Practice Address - Street 2:BOX 357131
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-7131
Practice Address - Country:US
Practice Address - Phone:206-221-0236
Practice Address - Fax:206-616-9520
Is Sole Proprietor?:No
Enumeration Date:2012-08-09
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADF60292957122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist