MEDICARE: DR. JOSEPH RYAN KOLODY D.D.S., M.S.D.

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	52878	CA

General Provider Information

NPI Number	:	1063536654
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH RYAN KOLODY D.D.S., M.S.D.

Provider Business Mailing Address
First Line	:	1600 COLORADO AVE
Second Line	:	2
City	:	TURLOCK
State	:	CA
Zip	:	95382-2713
Country	:	US
Telephone Number	:	209-668-7001
Fax Number	:

Provider Business Practice Location Address
First Line	:	1600 COLORADO AVE
Second Line	:	SUITE 2
City	:	TURLOCK
State	:	CA
Zip	:	95382-2713
Country	:	US
Telephone Number	:	209-668-7001
Fax Number	:

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

Provider Enumeration Date	:	03/19/2007
Last Update Date	:	07/08/2007

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