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COLTON CHARLES DMD

General Practice >> Dentist >> Dental Providers

Registrant NPI Number: 1073826772

Individual Registrant:
 COLTON  CHARLES DMD
Gender: M
Not Sole Proprietor

Location and contact information for practice:
509 PINE ST  MCCALL, ID 83638-5017 US
Tel: 208-634-7653  Fax: 208-634-4568

Contact information for business:
509 PINE ST  MCCALL, ID 83638-5017 US
Tel: 208-634-7653  Fax: 208-634-4568

Registration Information:
NPI: 1073826772
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y1223G0001XDental Providers
Dentist
General Practice
IDN-12447

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
STATE LICENSEN-12447ID01




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