Provider Demographics
NPI:1568532869
Name:COLTON, BRIGHAM G (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRIGHAM
Middle Name:G
Last Name:COLTON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7613 JORDAN LANDING BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84084-1972
Mailing Address - Country:US
Mailing Address - Phone:801-282-2323
Mailing Address - Fax:801-282-3440
Practice Address - Street 1:7613 JORDAN LANDING BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84084-1972
Practice Address - Country:US
Practice Address - Phone:801-282-2323
Practice Address - Fax:801-282-3440
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5926034-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice