Healthcare Provider Details

I. General information

NPI: 1841357662
Provider Name (Legal Business Name): JOHN ANDREW COLGAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 01/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 37TH PL SUITE 103
VERO BEACH FL
32960-6579
US

IV. Provider business mailing address

P. O. BOX 162906
MIAMI FL
33116-2906
US

V. Phone/Fax

Practice location:
  • Phone: 772-770-9191
  • Fax: 772-770-4161
Mailing address:
  • Phone: 772-770-9191
  • Fax: 772-770-4161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN14175
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: