Provider Demographics
NPI:1497719298
Name:COLINA, JOEY J (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOEY
Middle Name:J
Last Name:COLINA
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 1:1646 TAPPAHANNOCK
Mailing Address - Street 2:PO BOX 1237
Mailing Address - City:TAPPAHANNOCK
Mailing Address - State:VA
Mailing Address - Zip Code:22560
Mailing Address - Country:US
Mailing Address - Phone:804-443-5984
Mailing Address - Fax:804-443-3462
Practice Address - Street 1:1646 TAPPAHANNOCK
Practice Address - Street 2:
Practice Address - City:TAPPAHANNOCK
Practice Address - State:VA
Practice Address - Zip Code:22560
Practice Address - Country:US
Practice Address - Phone:804-443-5984
Practice Address - Fax:804-443-3462
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401007889122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist