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General NPI Number Information
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NPI Number | 1023028941
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Entity Type | Individual
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Provider Name | WALTER E. COLON II D.M.D.,M.S.DIPLOMATE
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Gender | Male
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Dates
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Enumeration Date | 08/09/2006
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Last Update Date | 12/26/2013
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Provider Practice Location Address
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Address Line | 1614 W PLAZA DR
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City | TALLAHASSEE
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State | FL
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Zip | 32308-5324
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Country | US
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Telephone | 850-562-6111
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Fax | 850-562-7263
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Provider Business Mailing Address
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Address Line | 1614 W PLAZA DR
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City | TALLAHASSEE
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State | FL
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Zip | 32308-5324
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Country | US
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Telephone | 850-562-6111
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Fax | 850-562-7263
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | DN15124
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License Number State | FL
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