Paul A Kollath, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

1857G Issued in WI

Practice address

2805 Libal St.
Ste. C
Green Bay, WI 54301-2877

Phone

(920) 339-8980

Fax

(920) 339-0133

NPI assigned

Dec 27, 2006

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WI

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

Practice roles

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

• Allouez Family Dental Center SC

  • General Practice Dentistry
  • Green Bay, WI
  • NPI 1477639102
  NPD (past) Authorized official
• Daniel Fama DDS LLC

  • Dental Clinic/Center
  • Green Bay, WI
  • NPI 1427794569
  NPD (past)

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

{
    "created_epoch": "1167177600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1447315460",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2805 LIBAL ST.",
            "address_2": "STE. C",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543012877",
            "telephone_number": "920-339-8980",
            "fax_number": "920-339-0133"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2805 LIBAL ST.",
            "address_2": "STE. C",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543012877",
            "telephone_number": "920-339-8980",
            "fax_number": "920-339-0133"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOLLATH",
        "first_name": "PAUL",
        "middle_name": "A",
        "name_prefix": "Mr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-27",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WI",
            "license": "1857G",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33353100",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kristin Koerten, PAC
• David William Kohls, APNP
• Christopher Britt Kolar, MD
• Anna Lee Kolb, LPN
• Nicolette Taylor Kollath, DDS
• Molly C Kollross, PT
• Matthew Kolonich, CRNA
• Kayla Kolstad
• Lucy Wanda Komorowski, DMD
• Jack Komro, DO

• Dentist in Green Bay, WI
• Providers in Green Bay, WI by specialty
• Dentist 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; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.