Individual
DR. MICHAEL THOMAS KOLODYCHAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
4600 ZUCK RD, ERIE, PA 16506-4932
(814) 838-2144
(814) 838-7227
Mailing address
4600 ZUCK RD, ERIE, PA 16506-4932
(814) 838-2144
(814) 838-7227
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
DS029985L
PA
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
DS029985L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DS029985L
STATE LICENSE
PA
Enumeration date
02/23/2006
Last updated
06/21/2021
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