Provider Demographics
NPI:1326329046
Name:FERRITER, COLLEEN MARIE (DMD)
Entity Type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:MARIE
Last Name:FERRITER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:COLLEEN
Other - Middle Name:MARIE
Other - Last Name:JOHNSRUD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:107 AGNES AVE
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-8732
Mailing Address - Country:US
Mailing Address - Phone:509-999-8257
Mailing Address - Fax:
Practice Address - Street 1:634 EDDY AVE
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59812
Practice Address - Country:US
Practice Address - Phone:406-243-5445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-08
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT24231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice