Provider Demographics
NPI:1699899039
Name:STEVEN G. KOLOKITHAS, DDS, A PROF. CORP.
Entity type:Organization
Organization Name:STEVEN G. KOLOKITHAS, DDS, A PROF. CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:KOLOKITHAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:650-368-1353
Mailing Address - Street 1:2920 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94062-1578
Mailing Address - Country:US
Mailing Address - Phone:650-368-1353
Mailing Address - Fax:650-365-5672
Practice Address - Street 1:2920 BROADWAY
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94062-1578
Practice Address - Country:US
Practice Address - Phone:650-368-1353
Practice Address - Fax:650-365-5672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41633261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental