Provider Demographics
NPI:1730128331
Name:KOLONSKY, EDWARD J JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:J
Last Name:KOLONSKY
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:437 W LLOYD ST
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH
Mailing Address - State:PA
Mailing Address - Zip Code:17976-1555
Mailing Address - Country:US
Mailing Address - Phone:570-462-2540
Mailing Address - Fax:
Practice Address - Street 1:27 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:PA
Practice Address - Zip Code:17976-1708
Practice Address - Country:US
Practice Address - Phone:570-462-4710
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS026931L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011724020002Medicaid
PA0011724020001Medicaid