| Dental Express Medina -jerry S. Kolosionek Dds Llc | |
|
750 E Washington St Suite A3 Medina OH 44256-2196 | |
| (330) 725-3887 | |
| Not Available |
| Full Name | Dental Express Medina -jerry S. Kolosionek Dds Llc |
|---|---|
| Speciality | Dentist |
| Location | 750 E Washington St, Medina, Ohio |
| Authorized Official Name and Position | Amy R Mauerman (EXECUTIVE ADMIN) |
| Authorized Official Contact | 3305333400 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Dental Express Medina -jerry S. Kolosionek Dds Llc 750 E Washington St Suite A3 Medina OH 44256-2196 Ph: (330) 725-3887 | Dental Express Medina -jerry S. Kolosionek Dds Llc 750 E Washington St Suite A3 Medina OH 44256-2196 Ph: (330) 725-3887 |
| NPI Number | 1770898074 |
|---|---|
| Provider Enumeration Date | 08/11/2010 |
| Last Update Date | 08/11/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770898074 | NPI | - | NPPES |
| 1143641-00-3 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 30-019480 (Ohio) | Primary |
| 122300000X | Dentist | 30-023197 (Ohio) | Secondary |
| 122300000X | Dentist | 30-023233 (Ohio) | Secondary |
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