Provider Demographics
NPI:1265533624
Name:COULSTON, HAROLD E JR (DMD)
Entity type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:E
Last Name:COULSTON
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
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Mailing Address - Street 1:6099 N 1ST ST
Mailing Address - Street 2:102
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-5462
Mailing Address - Country:US
Mailing Address - Phone:559-432-8100
Mailing Address - Fax:559-432-7420
Practice Address - Street 1:6099 N 1ST ST
Practice Address - Street 2:102
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5462
Practice Address - Country:US
Practice Address - Phone:559-432-8100
Practice Address - Fax:559-432-7420
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA206171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice