Provider Demographics
NPI:1578916599
Name:KOLENCHERRY, ANNA (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANNA
Middle Name:
Last Name:KOLENCHERRY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 STANHOPE DR
Mailing Address - Street 2:C
Mailing Address - City:WILLOWBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60527-2957
Mailing Address - Country:US
Mailing Address - Phone:630-362-8903
Mailing Address - Fax:
Practice Address - Street 1:232 STANHOPE DR
Practice Address - Street 2:C
Practice Address - City:WILLOWBROOK
Practice Address - State:IL
Practice Address - Zip Code:60527-2957
Practice Address - Country:US
Practice Address - Phone:630-362-8903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-14
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.030788122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist