Provider Demographics
NPI:1376631572
Name:KOLB & KOLB DDS LLC
Entity Type:Organization
Organization Name:KOLB & KOLB DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:W
Authorized Official - Last Name:KOLB
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:812-897-3470
Mailing Address - Street 1:PO BOX 167
Mailing Address - Street 2:602 W LOCUST ST
Mailing Address - City:BOONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47601-0167
Mailing Address - Country:US
Mailing Address - Phone:812-897-3470
Mailing Address - Fax:812-897-0068
Practice Address - Street 1:602 W LOCUST ST
Practice Address - Street 2:
Practice Address - City:BOONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47601-0167
Practice Address - Country:US
Practice Address - Phone:812-897-3470
Practice Address - Fax:812-897-0068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty