Andrew John Kollath

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D14111 Issued in MN

Practice address

7270 Forestview LN N Ste 250
Maple Grove, MN 55369

Phone

(763) 424-9202

NPI assigned

Jul 28, 2017

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

Medicare enrollment (NPD)

Not 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)
• 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": "1501200000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1563753600000",
    "number": "1902320286",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7270 FORESTVIEW LN N STE 250",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553695605",
            "telephone_number": "763-424-9202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7270 FORESTVIEW LN N STE 250",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "55369",
            "telephone_number": "763-424-9202"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7270 Forestview Ln N Ste 250",
            "address_purpose": "LOCATION",
            "city": "Maple Grove",
            "state": "MN",
            "postal_code": "55369",
            "country_code": "US",
            "telephone_number": "763-424-9202",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOLLATH",
        "first_name": "ANDREW",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-07-28",
        "last_updated": "2019-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "1001549",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D14111",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brenda Kodl
• Tara Koepke
• Jill Marie Koerber, P.T.
• Alexandra Nicole Koes, PA-C
• Pamela Kolacz, M.D.
• Patricia Ann Koning, DDS
• Ibolya Konkoly, DC
• Andrea Konz
• Heidi Kopacek, PSYD, LP
• Mark Korthals, OD

• General Practice Dentistry in Maple Grove, MN
• Providers in Maple Grove, MN by specialty
• General Practice Dentistry in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2019; 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.