Provider Demographics
NPI:1366689804
Name:AU, COLIN KAMLAND (DDS)
Entity Type:Individual
Prefix:DR
First Name:COLIN
Middle Name:KAMLAND
Last Name:AU
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 1:2460 MISSION ST
Mailing Address - Street 2:SUITE 109
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-2467
Mailing Address - Country:US
Mailing Address - Phone:415-401-7380
Mailing Address - Fax:
Practice Address - Street 1:2460 MISSION ST
Practice Address - Street 2:SUITE 109
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-2467
Practice Address - Country:US
Practice Address - Phone:415-401-7380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-20
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA578041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice