Provider Demographics
NPI:1407993058
Name:COLON, NOEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:NOEL
Middle Name:
Last Name:COLON
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:PO BOX 2128
Mailing Address - Street 2:
Mailing Address - City:MOROVIS
Mailing Address - State:PR
Mailing Address - Zip Code:00687-4128
Mailing Address - Country:US
Mailing Address - Phone:787-862-3667
Mailing Address - Fax:
Practice Address - Street 1:2 CALLE PATRON
Practice Address - Street 2:
Practice Address - City:MOROVIS
Practice Address - State:PR
Practice Address - Zip Code:00687-3021
Practice Address - Country:US
Practice Address - Phone:787-862-3667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR23571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR7460OtherFIRST MEDICAL
PR42297OtherSSS
PR583236181OtherDELTA DENTAL PLAN
PR041900OtherCRUZ AZUL DE PUERTO RICO
PR9180267OtherHUMANA HEALTH CARE