Provider Demographics
NPI:1275617680
Name:COLBURN, WILLIAM MANLEY (DMD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:MANLEY
Last Name:COLBURN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2810 20TH AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:NORTHPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35476-3835
Mailing Address - Country:US
Mailing Address - Phone:205-339-1777
Mailing Address - Fax:205-339-8200
Practice Address - Street 1:2810 20TH AVE
Practice Address - Street 2:SUITE A
Practice Address - City:NORTHPORT
Practice Address - State:AL
Practice Address - Zip Code:35476-3835
Practice Address - Country:US
Practice Address - Phone:205-339-1777
Practice Address - Fax:205-339-8200
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL43581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice