Healthcare Provider Details

I. General information

NPI: 1154453124
Provider Name (Legal Business Name): COLONYA CHAROLYNN CALHOUN DDS, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 02/08/2022
Certification Date: 02/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 N UNIVERSITY AVE
ANN ARBOR MI
48109-1078
US

IV. Provider business mailing address

29949 BAYVIEW DR
GROSSE ILE MI
48138-1947
US

V. Phone/Fax

Practice location:
  • Phone: 734-764-1542
  • Fax: 734-615-1415
Mailing address:
  • Phone: 310-850-3579
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number53195
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number2901017840
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: