Provider Demographics
NPI:1700830999
Name:COLTHIRST, PAUL MAURICE (DDS)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:MAURICE
Last Name:COLTHIRST
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 1:752 DURFEE CT
Mailing Address - Street 2:
Mailing Address - City:FORT WAINWRIGHT
Mailing Address - State:AK
Mailing Address - Zip Code:99703-1416
Mailing Address - Country:US
Mailing Address - Phone:907-356-2228
Mailing Address - Fax:
Practice Address - Street 1:1005 SHOEMAKER DRIVE
Practice Address - Street 2:BLDG. 36000
Practice Address - City:FORT HOOD
Practice Address - State:TX
Practice Address - Zip Code:76544
Practice Address - Country:US
Practice Address - Phone:254-287-8887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN012701122300000X, 1223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health
No122300000XDental ProvidersDentist