Provider Demographics
NPI:1396849089
Name:KOLKER, JUSTINE LANE (DDS MS PHD)
Entity Type:Individual
Prefix:DR
First Name:JUSTINE
Middle Name:LANE
Last Name:KOLKER
Suffix:
Gender:F
Credentials:DDS MS PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:257 S DENTAL SCIENCE BLDG
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1001
Mailing Address - Country:US
Mailing Address - Phone:319-335-7431
Mailing Address - Fax:319-335-7155
Practice Address - Street 1:322 S DENTAL SCIENCE BLDG
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1001
Practice Address - Country:US
Practice Address - Phone:319-335-7440
Practice Address - Fax:319-335-7451
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA7830122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0477695Medicaid