Provider Demographics
NPI:1265792154
Name:KOLARIK, PAUL
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:
Last Name:KOLARIK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9307 BALLENTINE ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66214-1810
Mailing Address - Country:US
Mailing Address - Phone:913-710-4660
Mailing Address - Fax:
Practice Address - Street 1:9226 PFLUMM RD
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66215-3346
Practice Address - Country:US
Practice Address - Phone:913-888-6220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-24
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS60807122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist