Healthcare Provider Details

I. General information

NPI: 1932263100
Provider Name (Legal Business Name): ADAM S COLOMBO DDS, PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7301 MISSION RD SUITE 317
PRAIRIE VILLAGE KS
66208-3006
US

IV. Provider business mailing address

7301 MISSION RD SUITE 317
PRAIRIE VILLAGE KS
66208-3006
US

V. Phone/Fax

Practice location:
  • Phone: 913-236-7668
  • Fax:
Mailing address:
  • Phone: 913-236-7668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number60318
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: