Provider Demographics
NPI:1073609608
Name:POOL, COLLEEN A (DDS)
Entity Type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:A
Last Name:POOL
Suffix:
Gender:F
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:PO BOX 565
Mailing Address - Street 2:
Mailing Address - City:NEW PALESTINE
Mailing Address - State:IN
Mailing Address - Zip Code:46163-0565
Mailing Address - Country:US
Mailing Address - Phone:317-441-2418
Mailing Address - Fax:
Practice Address - Street 1:5774 W US 52
Practice Address - Street 2:
Practice Address - City:NEW PALESTINE
Practice Address - State:IN
Practice Address - Zip Code:46163-9737
Practice Address - Country:US
Practice Address - Phone:317-861-4484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120108421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice