Provider Demographics
NPI:1932169802
Name:OAK VALLEY DENTAL ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:OAK VALLEY DENTAL ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEF
Authorized Official - Middle Name:N
Authorized Official - Last Name:KOLLING
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:734-761-1122
Mailing Address - Street 1:2411 OAK VALLEY DR
Mailing Address - Street 2:SUITE 600
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-8876
Mailing Address - Country:US
Mailing Address - Phone:734-761-1122
Mailing Address - Fax:734-761-9664
Practice Address - Street 1:2411 OAK VALLEY DR
Practice Address - Street 2:SUITE 600
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-8876
Practice Address - Country:US
Practice Address - Phone:734-761-1122
Practice Address - Fax:734-761-9664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0128161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty