Provider Demographics
NPI:1992053979
Name:MATTHEW C KOLAR DDS PC
Entity type:Organization
Organization Name:MATTHEW C KOLAR DDS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:C
Authorized Official - Last Name:KOLAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:940-663-5353
Mailing Address - Street 1:PO BOX 486
Mailing Address - Street 2:
Mailing Address - City:QUANAH
Mailing Address - State:TX
Mailing Address - Zip Code:79252-0486
Mailing Address - Country:US
Mailing Address - Phone:940-663-5353
Mailing Address - Fax:940-663-5911
Practice Address - Street 1:104 W 3RD ST
Practice Address - Street 2:
Practice Address - City:QUANAH
Practice Address - State:TX
Practice Address - Zip Code:79252-4034
Practice Address - Country:US
Practice Address - Phone:940-663-5353
Practice Address - Fax:940-663-5911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-22
Last Update Date:2012-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX272771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty