Provider Demographics
NPI:1861922908
Name:KOLATHU, KUNJUMARY JOHN (DDS)
Entity type:Individual
Prefix:DR
First Name:KUNJUMARY
Middle Name:JOHN
Last Name:KOLATHU
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11205 DUNLOP TER
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78754-2158
Mailing Address - Country:US
Mailing Address - Phone:616-920-4955
Mailing Address - Fax:
Practice Address - Street 1:12901 N INTERSTATE 35 STE 1320
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78753-1028
Practice Address - Country:US
Practice Address - Phone:512-990-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-12
Last Update Date:2017-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX329621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice