Provider Demographics
NPI:1477546836
Name:MCCOLM, EARL DAYTON (DDS)
Entity Type:Individual
Prefix:
First Name:EARL
Middle Name:DAYTON
Last Name:MCCOLM
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 1:602 LIBERTY STREET
Mailing Address - Street 2:PO BOX 368
Mailing Address - City:OSKALOOSA
Mailing Address - State:KS
Mailing Address - Zip Code:66066-0368
Mailing Address - Country:US
Mailing Address - Phone:785-863-2208
Mailing Address - Fax:785-863-2967
Practice Address - Street 1:602 LIBERTY STREET
Practice Address - Street 2:
Practice Address - City:OSKALOOSA
Practice Address - State:KS
Practice Address - Zip Code:66066-0368
Practice Address - Country:US
Practice Address - Phone:785-863-2208
Practice Address - Fax:785-863-2967
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS67871223G0001X
MO0153221223G0001X
OR070681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice