Provider Demographics
NPI:1124784384
Name:KOLA DENTISTRY, PLLC
Entity type:Organization
Organization Name:KOLA DENTISTRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JAMISEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KOHLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:512-472-5633
Mailing Address - Street 1:2907 DUVAL ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-3820
Mailing Address - Country:US
Mailing Address - Phone:512-472-5633
Mailing Address - Fax:
Practice Address - Street 1:2907 DUVAL ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-3820
Practice Address - Country:US
Practice Address - Phone:512-472-5633
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-11
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental