Provider Demographics
NPI:1023369816
Name:COLBERT, JAMES J (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:J
Last Name:COLBERT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3210 18TH ST S
Mailing Address - Street 2:SUITE B
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-6789
Mailing Address - Country:US
Mailing Address - Phone:701-237-6008
Mailing Address - Fax:701-893-3017
Practice Address - Street 1:3210 18TH ST S
Practice Address - Street 2:SUITE B
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-6789
Practice Address - Country:US
Practice Address - Phone:701-237-6008
Practice Address - Fax:701-893-3017
Is Sole Proprietor?:No
Enumeration Date:2012-09-20
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDND18791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice