Healthcare Provider Details

I. General information

NPI: 1780474254
Provider Name (Legal Business Name): KAYLA PATRICIA KOLODYCHAK DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2025
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 E MEDICAL CENTER DR SPC 5346
ANN ARBOR MI
48109-5346
US

IV. Provider business mailing address

551 LORD RD
FAIRVIEW PA
16415-1525
US

V. Phone/Fax

Practice location:
  • Phone: 734-936-8289
  • Fax:
Mailing address:
  • Phone: 814-969-6576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number13107
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number1780474254
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: