Provider Demographics
NPI:1932459260
Name:COLBERT, DENISE YVONNE (DDS)
Entity Type:Individual
Prefix:DR
First Name:DENISE
Middle Name:YVONNE
Last Name:COLBERT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1395
Mailing Address - Street 2:
Mailing Address - City:FREDERIKSTED
Mailing Address - State:VI
Mailing Address - Zip Code:00841-1395
Mailing Address - Country:US
Mailing Address - Phone:340-719-9991
Mailing Address - Fax:340-719-8963
Practice Address - Street 1:4500 SION FARM
Practice Address - Street 2:SUITE 1C ISLAND MEDICAL CENTER
Practice Address - City:CHRISTIANSTED
Practice Address - State:VI
Practice Address - Zip Code:00823
Practice Address - Country:US
Practice Address - Phone:340-719-9991
Practice Address - Fax:340-719-8963
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-13
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI10201223X0400X
VI135-PH183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No183500000XPharmacy Service ProvidersPharmacist