MEDICARE: DR. CONNOR COLVIN DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	30.027297	OH

General Provider Information

NPI Number	:	1003540121
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CONNOR COLVIN DDS

Provider Business Mailing Address
First Line	:	2607 E MAIN ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43209-2445
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2607 E MAIN ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43209-2445
Country	:	US
Telephone Number	:	614-237-3781
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2022
Last Update Date	:	10/06/2023

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