Healthcare Provider Details

I. General information

NPI: 1700830999
Provider Name (Legal Business Name): PAUL MAURICE COLTHIRST D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 12/06/2024
Certification Date: 12/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 JARRETT WHITE RD
TRIPLER ARMY MEDICAL CENTER HI
96859-5001
US

IV. Provider business mailing address

752 DURFEE CT
FORT WAINWRIGHT AK
99703-1416
US

V. Phone/Fax

Practice location:
  • Phone: 808-787-3040
  • Fax:
Mailing address:
  • Phone: 907-356-2228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN012701
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN012701
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License NumberDN012701
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: