Healthcare Provider Details

I. General information

NPI: 1912461294
Provider Name (Legal Business Name): NICHOLAS KOLAR DDS, MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2019
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9240 N MERIDIAN ST STE 300
INDIANAPOLIS IN
46260-1822
US

IV. Provider business mailing address

5537 BROADWAY ST
INDIANAPOLIS IN
46220-3070
US

V. Phone/Fax

Practice location:
  • Phone: 317-846-7377
  • Fax:
Mailing address:
  • Phone: 260-413-6153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number12014281A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: