MEDICARE: COLBY DENTAL, 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

General Provider Information

NPI Number	:	1831353259
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLBY DENTAL, DDS

Provider Business Mailing Address
First Line	:	1939 W 45TH AVE
Second Line	:
City	:	GRIFFITH
State	:	IN
Zip	:	46319-3703
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1939 W 45TH AVE
Second Line	:
City	:	GRIFFITH
State	:	IN
Zip	:	46319-3703
Country	:	US
Telephone Number	:	219-924-2736
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TIMOTHY E COLBY
Credential	:
Telephone Number	:	219-924-2736

Provider Enumeration Date	:	07/15/2008
Last Update Date	:	07/15/2008

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