Provider Demographics
NPI:1649360348
Name:KOLESAR, MATTHEW R
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:R
Last Name:KOLESAR
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 1:2311 M ST NW
Mailing Address - Street 2:SUITE 500
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20037-1445
Mailing Address - Country:US
Mailing Address - Phone:202-296-3360
Mailing Address - Fax:202-728-0294
Practice Address - Street 1:2311 M ST NW
Practice Address - Street 2:SUITE 500
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-1445
Practice Address - Country:US
Practice Address - Phone:202-296-3360
Practice Address - Fax:202-728-0294
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN10005371223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCDEN1000537OtherDC DENTAL LICENSE NUMBER