Provider Demographics
NPI:1568475218
Name:DOUGLA R. COLTHURST D.D.S.,INC
Entity Type:Organization
Organization Name:DOUGLA R. COLTHURST D.D.S.,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:R
Authorized Official - Last Name:COLTHURST
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:815-344-0453
Mailing Address - Street 1:3420 W ELM ST
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-4433
Mailing Address - Country:US
Mailing Address - Phone:815-344-0453
Mailing Address - Fax:815-344-3588
Practice Address - Street 1:3420 W ELM ST
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-4433
Practice Address - Country:US
Practice Address - Phone:815-344-0453
Practice Address - Fax:815-344-3588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty