Provider Demographics
NPI:1841357662
Name:COLGAN, JOHN ANDREW (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ANDREW
Last Name:COLGAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:P. O. BOX 162906
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33116-2906
Mailing Address - Country:US
Mailing Address - Phone:772-770-9191
Mailing Address - Fax:772-770-4161
Practice Address - Street 1:1000 37TH PL
Practice Address - Street 2:SUITE 103
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-6579
Practice Address - Country:US
Practice Address - Phone:772-770-9191
Practice Address - Fax:772-770-4161
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN141751223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL85369YMedicare PIN