Provider Demographics
NPI:1417235847
Name:KOLODZIEJ, PAUL R (DMD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:R
Last Name:KOLODZIEJ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:PAUL
Other - Middle Name:R
Other - Last Name:KOLODZIEJ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:PO BOX 1062
Mailing Address - Street 2:
Mailing Address - City:ELFERS
Mailing Address - State:FL
Mailing Address - Zip Code:34680-1062
Mailing Address - Country:US
Mailing Address - Phone:954-684-1852
Mailing Address - Fax:
Practice Address - Street 1:2682 W LAKE RD
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-3120
Practice Address - Country:US
Practice Address - Phone:727-785-4461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-03
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 19514122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist