MEDICARE: DR. STEVEN GEORGE KOLOKITHAS D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	41633	CA

General Provider Information

NPI Number	:	1932322567
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEVEN GEORGE KOLOKITHAS D.D.S.

Provider Business Mailing Address
First Line	:	35 OAKDALE ST
Second Line	:
City	:	REDWOOD CITY
State	:	CA
Zip	:	94062-1734
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2920 BROADWAY
Second Line	:
City	:	REDWOOD CITY
State	:	CA
Zip	:	94062-1578
Country	:	US
Telephone Number	:	650-368-1353
Fax Number	:	650-365-5672

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2007
Last Update Date	:	07/08/2007

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