Nicolette Taylor Kollath, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D14028 Issued in MN

Practice address

704 S. Webster Ave #402
Green Bay, WI 54301

Phone

(920) 432-6894

NPI assigned

Jun 1, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Nicolette Taylor Klucas Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1527811200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689552000000",
    "number": "1982196317",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "704 S. WEBSTER AVE #402",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "54301",
            "telephone_number": "612-508-7862"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "704 S. WEBSTER AVE #402",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "54301",
            "telephone_number": "920-432-6894"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOLLATH",
        "first_name": "NICOLETTE",
        "middle_name": "TAYLOR",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-06-01",
        "last_updated": "2023-07-17",
        "certification_date": "2023-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D14028",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "6001156-15",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICOLETTE",
            "last_name": "KLUCAS",
            "middle_name": "TAYLOR",
            "credential": "DDS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Cindy Marie Koerner, CCC SLP
• Kristin Koerten, PAC
• David William Kohls, APNP
• Christopher Britt Kolar, MD
• Anna Lee Kolb, LPN
• Paul A Kollath, DDS
• Molly C Kollross, PT
• Matthew Kolonich, CRNA
• Kayla Kolstad
• Lucy Wanda Komorowski, DMD

• General Practice Dentistry in Green Bay, WI
• Providers in Green Bay, WI by specialty
• General Practice Dentistry in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2023; 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.