Dental Express Medina -Jerry S. Kolosionek DDS LLC

Primary specialty

DentistTaxonomy code 122300000X

License

30-019480 Issued in OH

Legal business name

DENTAL EXPRESS MEDINA -JERRY S. KOLOSIONEK DDS LLC

Practice address

750 E Washington St
Suite A3
Medina, OH 44256-2196

Phone

(330) 725-3887

NPI assigned

Aug 11, 2010

Last updated

Aug 11, 2010By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Amy R Mauerman

Title

Executive Admin

Phone

(330) 533-3400

Specialties & licenses 3

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1281484800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1281484800000",
    "number": "1770898074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "750 E WASHINGTON ST",
            "address_2": "SUITE A3",
            "city": "MEDINA",
            "state": "OH",
            "postal_code": "442562196",
            "telephone_number": "330-725-3887"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 E WASHINGTON ST",
            "address_2": "SUITE A3",
            "city": "MEDINA",
            "state": "OH",
            "postal_code": "442562196",
            "telephone_number": "330-725-3887"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTAL EXPRESS MEDINA -JERRY S. KOLOSIONEK DDS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-11",
        "last_updated": "2010-08-11",
        "status": "A",
        "authorized_official_last_name": "MAUERMAN",
        "authorized_official_first_name": "AMY",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "EXECUTIVE ADMIN",
        "authorized_official_telephone_number": "330-533-3400"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OH",
            "license": "30-019480",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OH",
            "license": "30-023197",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OH",
            "license": "30-023233",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1143641-00-3",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• 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 Aug 11, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.