Individual
DR. JUSTIN R KOLASA
Active
Individual
DR. JUSTIN R KOLASA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D., M.D.
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
9346
KY
174400000X
Specialist
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100290020
—
KY
Enumeration date
05/07/2013
Last updated
01/18/2023
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