Provider Demographics
NPI:1063536654
Name:KOLODY, JOSEPH RYAN (DDS, MSD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:RYAN
Last Name:KOLODY
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 COLORADO AVE
Mailing Address - Street 2:2
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95382-2713
Mailing Address - Country:US
Mailing Address - Phone:209-668-7001
Mailing Address - Fax:
Practice Address - Street 1:1600 COLORADO AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95382-2713
Practice Address - Country:US
Practice Address - Phone:209-668-7001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA528781223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics