Organization
EDWARD J. KOLONSKY DMD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EDWARD J KOLONSKY JR. D.M.D (PRESIDENT/SECRETARY)
(570) 462-4710
Entity
Organization
Contact information
Practice address
27 W WASHINGTON ST, SHENANDOAH, PA 17976-1708
(570) 462-4710
Mailing address
437 W LLOYD ST, SHENANDOAH, PA 17976-1555
(570) 462-4710
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DS026931L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0011724020001
—
PA
Enumeration date
04/17/2013
Last updated
04/17/2013
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