Provider Demographics
NPI:1952509358
Name:COLKMIRE, JOSHUA MATTHEW (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:MATTHEW
Last Name:COLKMIRE
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 1:1657 SE PORT ST LUCIE BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-5428
Mailing Address - Country:US
Mailing Address - Phone:772-337-4115
Mailing Address - Fax:772-337-4116
Practice Address - Street 1:1657 SE PORT ST LUCIE BLVD
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-5428
Practice Address - Country:US
Practice Address - Phone:772-337-4115
Practice Address - Fax:772-337-4116
Is Sole Proprietor?:No
Enumeration Date:2007-07-06
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL180431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice