Provider Demographics
NPI:1790889046
Name:KOLB, JEFFREY P (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:P
Last Name:KOLB
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 167
Mailing Address - Street 2:602 W LOCUST ST
Mailing Address - City:BOONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47601-0167
Mailing Address - Country:US
Mailing Address - Phone:812-897-3470
Mailing Address - Fax:812-897-0068
Practice Address - Street 1:602 W LOCUST ST
Practice Address - Street 2:
Practice Address - City:BOONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47601-0167
Practice Address - Country:US
Practice Address - Phone:812-897-3470
Practice Address - Fax:812-897-0068
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12008977122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist