Provider Demographics
NPI:1952602005
Name:COLON, IVAN CHRISTOPHER (DDS)
Entity Type:Individual
Prefix:DR
First Name:IVAN
Middle Name:CHRISTOPHER
Last Name:COLON
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 1:599 FARRINGTON HWY
Mailing Address - Street 2:STE. 205
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-2028
Mailing Address - Country:US
Mailing Address - Phone:808-674-9090
Mailing Address - Fax:
Practice Address - Street 1:599 FARRINGTON HWY
Practice Address - Street 2:STE. 205
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-2028
Practice Address - Country:US
Practice Address - Phone:808-674-9090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-05
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT-24261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice