Provider Demographics
NPI:1437313939
Name:ERNEST J COLVIN & ASSO
Entity Type:Organization
Organization Name:ERNEST J COLVIN & ASSO
Other - Org Name:ERNEST J COLVIN DDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:OLA
Authorized Official - Middle Name:C
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-664-1900
Mailing Address - Street 1:4413 1/2 PARK HEIGHTS AVENUE
Mailing Address - Street 2:PO BOX 2672
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215
Mailing Address - Country:US
Mailing Address - Phone:410-664-1900
Mailing Address - Fax:410-664-1906
Practice Address - Street 1:4413 1/2 PARK HEIGHTS AVENUE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215
Practice Address - Country:US
Practice Address - Phone:410-664-1900
Practice Address - Fax:410-664-1906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-14
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD4553122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty