Provider Demographics
NPI:1922003185
Name:JOLKOVSKY, DAVID L (DMD,MS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:L
Last Name:JOLKOVSKY
Suffix:
Gender:M
Credentials:DMD,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 DRAKE DR
Mailing Address - Street 2:STE B
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-0856
Mailing Address - Country:US
Mailing Address - Phone:530-758-1530
Mailing Address - Fax:530-758-1236
Practice Address - Street 1:1205 DRAKE DR
Practice Address - Street 2:STE B
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-0856
Practice Address - Country:US
Practice Address - Phone:530-758-1530
Practice Address - Fax:530-758-1236
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA351281223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics