MEDICARE: DR. CYNTHIA L COLSON D.M.D.

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	D5878	AZ
2	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	DS0000007681	TN
3	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	58053	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316949282
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CYNTHIA L COLSON D.M.D.

Provider Business Mailing Address
First Line	:	161 RAILROAD ST S
Second Line	:
City	:	MC EWEN
State	:	TN
Zip	:	37101-4762
Country	:	US
Telephone Number	:	931-582-6997
Fax Number	:	931-582-6989

Provider Business Practice Location Address
First Line	:	161 RAILROAD ST S
Second Line	:
City	:	MC EWEN
State	:	TN
Zip	:	37101-4762
Country	:	US
Telephone Number	:	931-582-6997
Fax Number	:	931-582-6989

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

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	02/10/2009

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Directions to “ DR. CYNTHIA L COLSON D.M.D.” Practice Location

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