Provider Demographics
NPI:1851570402
Name:COLBERT, SHAWN DANIEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:DANIEL
Last Name:COLBERT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1685 CROWN AVE
Mailing Address - Street 2:PEDIATRIC DENTISTRY
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-6322
Mailing Address - Country:US
Mailing Address - Phone:717-295-4400
Mailing Address - Fax:717-295-1389
Practice Address - Street 1:1685 CROWN AVE
Practice Address - Street 2:PEDIATRIC DENTISTRY
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-6322
Practice Address - Country:US
Practice Address - Phone:717-295-4400
Practice Address - Fax:717-295-1389
Is Sole Proprietor?:No
Enumeration Date:2007-10-31
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS036976122300000X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist