Provider Demographics
NPI:1760721153
Name:COLONDDS P.C.
Entity Type:Organization
Organization Name:COLONDDS P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAGMAR
Authorized Official - Middle Name:E
Authorized Official - Last Name:COLON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:812-288-4691
Mailing Address - Street 1:409 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-3507
Mailing Address - Country:US
Mailing Address - Phone:812-288-4691
Mailing Address - Fax:812-288-7178
Practice Address - Street 1:409 W 6TH ST
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-3507
Practice Address - Country:US
Practice Address - Phone:812-288-4691
Practice Address - Fax:812-288-7178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-06
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009554122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty