Thomas A Kolodge, DDS, MD

Primary specialty

Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X

License

MD126317 Issued in OR

Practice address

1046 NE 3Rd St
McMinnville, OR 97128-4418

Phone

(503) 472-1468

NPI assigned

Mar 30, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Apr 23, 2019 through Apr 23, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Mountain View Oral Surgery and Dental Implants

  • Oral and Maxillofacial Surgery (Dentist)
  • McMinnville, OR
  • NPI 1366756389
  NPD (past)

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

{
    "created_epoch": "1175212800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1470960000000",
    "number": "1639299100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1046 NE 3RD ST",
            "city": "MCMINNVILLE",
            "state": "OR",
            "postal_code": "971284418",
            "telephone_number": "503-472-1468"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1046 NE 3RD ST",
            "city": "MCMINNVILLE",
            "state": "OR",
            "postal_code": "971284418",
            "telephone_number": "503-472-1468"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOLODGE",
        "first_name": "THOMAS",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "DDS, MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-30",
        "last_updated": "2016-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "OR",
            "license": "D9272",
            "primary": false
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "OR",
            "license": "MD126317",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert Charles Koehler
• Dianne K Koenig, PA
• Terri Koenig
• William J. Koenig, D.O.
• Daphna Rivah Kohn, LAC
• Jana Konkolewski
• Thomas Konkolewski
• Denise Kathryn Krackenberger, ACNP
• Gabrielle Krause
• Dag Kremer, M.D.

• Oral & Maxillofacial Surgery (D.M.D.) in McMinnville, OR
• Providers in McMinnville, OR by specialty
• Oral & Maxillofacial Surgery (D.M.D.) in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2016; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.