Provider Demographics
NPI:1376619452
Name:CONCEPCION, COLLEEN RAFFERTY (DMD)
Entity Type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:RAFFERTY
Last Name:CONCEPCION
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:COLLEEN
Other - Middle Name:GILLILAND
Other - Last Name:RAFFERTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:5390 PRINCETON CT
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-8877
Mailing Address - Country:US
Mailing Address - Phone:810-360-3093
Mailing Address - Fax:
Practice Address - Street 1:725 N MILFORD RD
Practice Address - Street 2:MADDEN, ANDREWS AND ASSOCIATES
Practice Address - City:MILFORD
Practice Address - State:MI
Practice Address - Zip Code:48381-1536
Practice Address - Country:US
Practice Address - Phone:248-685-8748
Practice Address - Fax:248-685-0881
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO72921223G0001X
MI29010195001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice