Provider Demographics
NPI:1972655736
Name:KOLODNEY, JR., HAROLD (D M D)
Entity Type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:
Last Name:KOLODNEY, JR.
Suffix:
Gender:M
Credentials:D M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7728 OLD CANTON RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-6103
Mailing Address - Country:US
Mailing Address - Phone:601-856-4420
Mailing Address - Fax:601-853-1592
Practice Address - Street 1:7728 OLD CANTON RD
Practice Address - Street 2:SUITE B
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-6103
Practice Address - Country:US
Practice Address - Phone:601-856-4420
Practice Address - Fax:601-853-1592
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPROS-274-941223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00660338Medicaid
MS302I195812Medicare PIN