Provider Demographics
NPI:1790007417
Name:NOTHERN, COLLEEN (DDS)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:NOTHERN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3007 WILLIAMS DR
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-2778
Mailing Address - Country:US
Mailing Address - Phone:512-869-2563
Mailing Address - Fax:512-863-9372
Practice Address - Street 1:3007 WILLIAMS DR
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-2778
Practice Address - Country:US
Practice Address - Phone:512-869-2563
Practice Address - Fax:512-863-9372
Is Sole Proprietor?:No
Enumeration Date:2010-02-22
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21969122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist