Timothy James Koll, D.D.S.

Primary specialty

Oral and Maxillofacial Pathology DentistryTaxonomy code 1223P0106X

License

4243 Issued in WI

Practice address

2410 E. Evergreen Dr.
Appleton, WI 54913-4913

Phone

(920) 832-9500

Fax

(920) 832-9490

NPI assigned

Oct 19, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jun 7, 2022 through Jun 7, 2028

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Apple Creek Oral Surgery, SC

  • Oral and Maxillofacial Pathology Dentistry
  • Appleton, WI
  • NPI 1275753659
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161216000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1154403194",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2410 E. EVERGREEN DR.",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549134913",
            "telephone_number": "920-832-9500",
            "fax_number": "920-832-9490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2410 E. EVERGREEN DR.",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549134913",
            "telephone_number": "920-832-9500",
            "fax_number": "920-832-9490"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOLL",
        "first_name": "TIMOTHY",
        "middle_name": "JAMES",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-19",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0106X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Pathology",
            "state": "WI",
            "license": "4243",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chelsea Leigh Kohlbeck, APNP
• Mary Jo Kohler, APNP
• Auburn Kohlman, PHARMD
• Obrad S Kokanovic, M.D
• Sara Anne Kokko, MS CCC-SLP
• Celine A Konetzke, SAC-IT
• Trevor Konetzke, SAC-IT
• Elizabeth A Konkel
• Susan Deborah Konkle, PTA
• Kenneth E Konopka, DDS

• Oral and Maxillofacial Pathology Dentistry in Appleton, WI
• Providers in Appleton, WI by specialty
• Oral and Maxillofacial Pathology Dentistry in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.