Jerry Stanley Kolosionek, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

19480 Issued in OH

Practice address

750 E Washington St
Suite a-3
Medina, OH 44256-2196

Phone

(330) 725-3837

Fax

(330) 764-4065

NPI assigned

Sep 20, 2006

Sex

Male

Sole proprietor

Yes

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

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1396842209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "750 E WASHINGTON ST",
            "address_2": "SUITE A-3",
            "city": "MEDINA",
            "state": "OH",
            "postal_code": "442562196",
            "telephone_number": "330-725-3837",
            "fax_number": "330-764-4065"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 E WASHINGTON ST",
            "address_2": "SUITE A-3",
            "city": "MEDINA",
            "state": "OH",
            "postal_code": "442562196",
            "telephone_number": "330-725-3837",
            "fax_number": "330-764-4065"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOLOSIONEK",
        "first_name": "JERRY",
        "middle_name": "STANLEY",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-20",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OH",
            "license": "19480",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Erin T Klubnik, CDCA SWA
• Samantha Koeberle, BSW, LSW
• Stacia Michele Kogut, CNP
• Catherine R Kolleth, LPCC-S, LMFT
• Stephanie Kolodziej, OTR/L
• John Komara III, PHARM.D.
• Kontoveros Klobas Medina LLC (2K Dental)
• Jonathan Dean Kopen, PTA
• Keith Kopisch, APRN
• Heather Kopkas, QMHS, CMS

• Dentist in Medina, OH
• Providers in Medina, OH by specialty
• Dentist in Ohio

• 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; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.