Provider Demographics
NPI:1447309232
Name:KOLOS, GEORGE (DMD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:KOLOS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2160 NE 63RD CT
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-1335
Mailing Address - Country:US
Mailing Address - Phone:954-551-1622
Mailing Address - Fax:
Practice Address - Street 1:830 E OAKLAND PARK BLVD
Practice Address - Street 2:
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33334-2761
Practice Address - Country:US
Practice Address - Phone:954-262-7530
Practice Address - Fax:954-262-7529
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN112951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice