Provider Demographics
NPI:1538295126
Name:KOLCHANSKY DENTAL CORPORATION
Entity Type:Organization
Organization Name:KOLCHANSKY DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:KOLCHANSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:805-577-8333
Mailing Address - Street 1:5292 LINDLEY AVE
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-3518
Mailing Address - Country:US
Mailing Address - Phone:805-577-8333
Mailing Address - Fax:805-299-4515
Practice Address - Street 1:665 E LOS ANGELES AVE STE D
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-1853
Practice Address - Country:US
Practice Address - Phone:805-577-8333
Practice Address - Fax:805-299-4515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty