Provider Demographics
NPI:1346515186
Name:CHARLES D. KOLB INC.
Entity Type:Organization
Organization Name:CHARLES D. KOLB INC.
Other - Org Name:KOLB DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROSALINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:G
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-991-5652
Mailing Address - Street 1:4449 S ALAMEDA ST
Mailing Address - Street 2:STE #1
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78412-2464
Mailing Address - Country:US
Mailing Address - Phone:361-991-5652
Mailing Address - Fax:361-991-5653
Practice Address - Street 1:4449 S ALAMEDA ST
Practice Address - Street 2:STE #1
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78412-2464
Practice Address - Country:US
Practice Address - Phone:361-991-5652
Practice Address - Fax:361-991-5653
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHARLES D KOLB INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-03-13
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX93331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty