Provider Demographics
NPI:1548775349
Name:COLBY DENTAL CORPORATION
Entity Type:Organization
Organization Name:COLBY DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:DARWIN
Authorized Official - Last Name:COLBY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:760-723-3535
Mailing Address - Street 1:521 E ALVARADO ST
Mailing Address - Street 2:
Mailing Address - City:FALLBROOK
Mailing Address - State:CA
Mailing Address - Zip Code:92028-2313
Mailing Address - Country:US
Mailing Address - Phone:760-723-3535
Mailing Address - Fax:
Practice Address - Street 1:521 E ALVARADO ST
Practice Address - Street 2:
Practice Address - City:FALLBROOK
Practice Address - State:CA
Practice Address - Zip Code:92028-2313
Practice Address - Country:US
Practice Address - Phone:760-723-3535
Practice Address - Fax:760-723-3535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA645521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty