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Individual
DR. JONATHAN CHARLES KOLB
Active
Individual
DR. JONATHAN CHARLES KOLB
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
19462
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
976607
TRICARE
TX
Enumeration date
01/15/2007
Last updated
07/09/2007
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