Healthcare Provider Details

I. General information

NPI: 1164597985
Provider Name (Legal Business Name): DIONNE MICHELLE COLBERT DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

570 W LANIER AVE SUITE 100
FAYETTEVILLE GA
30214
US

IV. Provider business mailing address

435 CARTER AVE
ATLANTA GA
30317
US

V. Phone/Fax

Practice location:
  • Phone: 678-836-2128
  • Fax: 770-460-7307
Mailing address:
  • Phone: 404-378-0499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number011808
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: