Provider Demographics
NPI:1376750844
Name:EDGERLEY, COLLEEN ANN (DDS)
Entity Type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:ANN
Last Name:EDGERLEY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:COLLEEN
Other - Middle Name:ANN
Other - Last Name:CARMODY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:73 N MAGNOLIA WAY
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80230-6707
Mailing Address - Country:US
Mailing Address - Phone:720-984-6996
Mailing Address - Fax:
Practice Address - Street 1:2295 S CHAMBERS RD STE E
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-4547
Practice Address - Country:US
Practice Address - Phone:303-751-6511
Practice Address - Fax:303-283-5944
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO87981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO15658031Medicaid