Individual
DR. THOMAS A KOLODGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS, MD
Contact information
Practice address
1046 NE 3RD ST, MCMINNVILLE, OR 97128-4418
(503) 472-1468
Mailing address
1046 NE 3RD ST, MCMINNVILLE, OR 97128-4418
(503) 472-1468
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
D9272
OR
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
MD126317
OR
Other
Enumeration date
03/30/2007
Last updated
08/12/2016
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