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General NPI Number Information
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NPI Number | 1699247544
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Entity Type | Organization
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Legal Business Name | COLBURN DDS PC TT
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Dates
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Enumeration Date | 12/17/2018
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Last Update Date | 12/17/2018
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Provider Practice Location Address
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Address Line | 3535 PARK ST STE 100
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City | NORTON SHORES
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State | MI
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Zip | 49444-3736
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Country | US
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Telephone | 231-739-8047
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Fax |
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Provider Business Mailing Address
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Address Line | 3535 PARK ST STE 100
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City | NORTON SHORES
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State | MI
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Zip | 49444-3736
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Country | US
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Telephone | 231-739-8047
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Fax |
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Authorized Official
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Title or Position | OWNER /PRESIDENT
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Name | JEFFREY COLBURN
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Credential | DDS
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Telephone | 231-739-8047
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State |
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