Healthcare Provider Details

I. General information

NPI: 1700106341
Provider Name (Legal Business Name): COLTON C DOUGLAS DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2010
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 W 700 S
EPHRAIM UT
84627-1524
US

IV. Provider business mailing address

41 W 700 S
EPHRAIM UT
84627-1524
US

V. Phone/Fax

Practice location:
  • Phone: 435-258-9001
  • Fax:
Mailing address:
  • Phone: 435-258-9001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number76851749922
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: