Individual
DR. JOHAN I KOLMODIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1005 TANNER FORD BLVD, SUITE 102, HANAHAN, SC 29410
(843) 797-6287
(843) 797-6292
Mailing address
1005 TANNER FORD BLVD, SUITE 102, HANAHAN, SC 29410
(843) 797-6287
(843) 797-6292
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
3436
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
817149
UNITED CONCORDIA
—
01
—
963368
BLUE CROSS
GA
05
—
Z34368
—
SC
Enumeration date
02/24/2006
Last updated
02/03/2009
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