Provider Demographics
NPI:1932541059
Name:DR. KOLODNER DENTAL GROUP, INC.
Entity Type:Organization
Organization Name:DR. KOLODNER DENTAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:TATYANA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOLODNER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-761-9526
Mailing Address - Street 1:12215 VENTURA BLVD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-2533
Mailing Address - Country:US
Mailing Address - Phone:818-761-9526
Mailing Address - Fax:818-755-6757
Practice Address - Street 1:12215 VENTURA BLVD
Practice Address - Street 2:SUITE 115
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-2533
Practice Address - Country:US
Practice Address - Phone:818-761-9526
Practice Address - Fax:818-755-6757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-18
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty