Provider Demographics
NPI:1891681359
Name:KOLI, DHEERAJ KUMAR (DDS)
Entity type:Individual
Prefix:
First Name:DHEERAJ KUMAR
Middle Name:
Last Name:KOLI
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 1:9914 W MILITARY DR APT 618
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-1799
Mailing Address - Country:US
Mailing Address - Phone:213-275-9423
Mailing Address - Fax:
Practice Address - Street 1:534 10TH ST STE A1
Practice Address - Street 2:
Practice Address - City:FLORESVILLE
Practice Address - State:TX
Practice Address - Zip Code:78114-3199
Practice Address - Country:US
Practice Address - Phone:213-275-9423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-13
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX414421223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice