Provider Demographics
NPI:1023028941
Name:COLON, WALTER E II (DMD,MSDIPLOMATE)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:E
Last Name:COLON
Suffix:II
Gender:M
Credentials:DMD,MSDIPLOMATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1614 W PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-5324
Mailing Address - Country:US
Mailing Address - Phone:850-562-6111
Mailing Address - Fax:850-562-7263
Practice Address - Street 1:1614 W PLAZA DR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5324
Practice Address - Country:US
Practice Address - Phone:850-562-6111
Practice Address - Fax:850-562-7263
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2013-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN151241223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics