Provider Demographics
NPI:1114146362
Name:COLON-DEGLANS, LIZBETH MARIE (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:LIZBETH
Middle Name:MARIE
Last Name:COLON-DEGLANS
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CAROLINA SHOPPING COURT
Mailing Address - Street 2:PISO 6, SUITE 307
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00985
Mailing Address - Country:US
Mailing Address - Phone:787-768-6625
Mailing Address - Fax:787-768-6625
Practice Address - Street 1:CAROLINA SHOPPING COURT
Practice Address - Street 2:PISO 6, SUITE 307
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985
Practice Address - Country:US
Practice Address - Phone:787-768-6625
Practice Address - Fax:787-768-6625
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR23661223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics