Provider Demographics
NPI:1568928752
Name:JOSHUA COLT SWEETEN DDS PC
Entity Type:Organization
Organization Name:JOSHUA COLT SWEETEN DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:COLT
Authorized Official - Last Name:SWEETEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:208-351-5311
Mailing Address - Street 1:1190 SW 14TH AVE
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:OR
Mailing Address - Zip Code:97914-4224
Mailing Address - Country:US
Mailing Address - Phone:208-351-5311
Mailing Address - Fax:
Practice Address - Street 1:286 SW 4TH ST
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OR
Practice Address - Zip Code:97914-2610
Practice Address - Country:US
Practice Address - Phone:208-351-5311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-13
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental