Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 52878 | CA |
NPI | 1063536654 |
---|---|
Provider Name | Dr. Joseph Ryan Kolody |
First Address | Turlock, CA 95382-2713 |
Second Address | Turlock, CA 95382-2713 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2007 |
Last Update Date | 08/07/2007 |