MEDICARE: DR. ORLANDO LUIS COLON DMD

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	1888	PR

General Provider Information

NPI Number	:	1316914989
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ORLANDO LUIS COLON DMD

Provider Business Mailing Address
First Line	:	14023 MARTINIQUE ISLE DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32824-5627
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	340 MAGNOLIA CIR
Second Line	:
City	:	TYNDALL A F B
State	:	FL
Zip	:	32403-5604
Country	:	US
Telephone Number	:	850-283-7276
Fax Number	:

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

Provider Enumeration Date	:	03/02/2006
Last Update Date	:	07/08/2007

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