Provider Demographics
NPI:1639741937
Name:KOLB, CARLEY RENEE (DDS)
Entity type:Individual
Prefix:MRS
First Name:CARLEY
Middle Name:RENEE
Last Name:KOLB
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9989 E C AVE
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49083-9430
Mailing Address - Country:US
Mailing Address - Phone:269-491-1882
Mailing Address - Fax:
Practice Address - Street 1:USS COMSTOCK(LSD-45)
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96662-1733
Practice Address - Country:US
Practice Address - Phone:619-744-1349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-15
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901600977122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist