Provider Demographics
NPI:1093735219
Name:COLIGADO, EDWIN J (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:J
Last Name:COLIGADO
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 1:7810 FM 1960 RD E
Mailing Address - Street 2:SUITE 102
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77346-2252
Mailing Address - Country:US
Mailing Address - Phone:281-852-6424
Mailing Address - Fax:281-852-0831
Practice Address - Street 1:7810 FM 1960 RD E
Practice Address - Street 2:SUITE 102
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77346-2252
Practice Address - Country:US
Practice Address - Phone:281-852-6424
Practice Address - Fax:281-852-0831
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX164871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice