Provider Demographics
NPI:1841280724
Name:KOLLANDER, STEVEN ALAN (DDS)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:ALAN
Last Name:KOLLANDER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6083 MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-5908
Mailing Address - Country:US
Mailing Address - Phone:718-497-2700
Mailing Address - Fax:718-497-7322
Practice Address - Street 1:6083 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-5908
Practice Address - Country:US
Practice Address - Phone:718-497-2700
Practice Address - Fax:718-497-7322
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0351321223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00553562Medicaid
NY00460Medicare ID - Type Unspecified