Provider Demographics
NPI:1154637916
Name:SPITZIG, COLLEEN HAMBROOK (DMD)
Entity Type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:HAMBROOK
Last Name:SPITZIG
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:722 E MCNAB RD
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33060-9430
Mailing Address - Country:US
Mailing Address - Phone:954-781-0545
Mailing Address - Fax:
Practice Address - Street 1:722 E MCNAB RD
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33060-9430
Practice Address - Country:US
Practice Address - Phone:954-781-0545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-31
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN19115122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist