Provider Demographics
NPI:1699194936
Name:ROBERT KOLATAC, DMD PA
Entity Type:Organization
Organization Name:ROBERT KOLATAC, DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:KOLATAC
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:201-833-2058
Mailing Address - Street 1:1432 QUEEN ANNE RD
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-3518
Mailing Address - Country:US
Mailing Address - Phone:201-833-2058
Mailing Address - Fax:201-833-9626
Practice Address - Street 1:1432 QUEEN ANNE RD
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-3518
Practice Address - Country:US
Practice Address - Phone:201-833-2058
Practice Address - Fax:201-833-9626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-15
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI14183122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty