Provider Demographics
NPI:1669645917
Name:HAROLDJ COLBURN DDS, LLC
Entity Type:Organization
Organization Name:HAROLDJ COLBURN DDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:J
Authorized Official - Last Name:COLBURN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:864-574-5297
Mailing Address - Street 1:1410A JOHN B WHITE BLVD
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29306-3927
Mailing Address - Country:US
Mailing Address - Phone:864-574-5297
Mailing Address - Fax:
Practice Address - Street 1:1410A JOHN B WHITE BLVD
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29306-3927
Practice Address - Country:US
Practice Address - Phone:864-574-5297
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2225261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental