Provider Demographics
NPI:1386668671
Name:KOLB, DAVID R (DDS)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:R
Last Name:KOLB
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 1:137 E MORTON ST
Mailing Address - Street 2:P.O. BOX 356
Mailing Address - City:OAKLAND CITY
Mailing Address - State:IN
Mailing Address - Zip Code:47660-1819
Mailing Address - Country:US
Mailing Address - Phone:812-749-3049
Mailing Address - Fax:
Practice Address - Street 1:137 E MORTON ST
Practice Address - Street 2:
Practice Address - City:OAKLAND CITY
Practice Address - State:IN
Practice Address - Zip Code:47660-1819
Practice Address - Country:US
Practice Address - Phone:812-749-3049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN78761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice