Provider Demographics
NPI:1578532099
Name:COLBY, ALAN (DDS)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:
Last Name:COLBY
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 1:2727 N. OAKLAND AVE,
Mailing Address - Street 2:SUITE 104
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526
Mailing Address - Country:US
Mailing Address - Phone:217-875-4555
Mailing Address - Fax:217-233-6792
Practice Address - Street 1:2727 N. OAKLAND AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526
Practice Address - Country:US
Practice Address - Phone:217-875-4555
Practice Address - Fax:217-233-6792
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0177031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice