Provider Demographics
NPI:1700983608
Name:KOLANSKI, ROBERT J (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:J
Last Name:KOLANSKI
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:PO BOX 63
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:OH
Mailing Address - Zip Code:43977
Mailing Address - Country:US
Mailing Address - Phone:740-968-4482
Mailing Address - Fax:740-968-4482
Practice Address - Street 1:210 HIGH ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:OH
Practice Address - Zip Code:43977
Practice Address - Country:US
Practice Address - Phone:740-968-4482
Practice Address - Fax:740-968-4482
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH16084122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0446048Medicaid