Provider Demographics
NPI:1053524124
Name:COLB, MICHAEL A (DDS)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:COLB
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 1:3901 OUTLOOK BLVD
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81008-1698
Mailing Address - Country:US
Mailing Address - Phone:719-543-0000
Mailing Address - Fax:719-543-4330
Practice Address - Street 1:3901 OUTLOOK BLVD
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-1698
Practice Address - Country:US
Practice Address - Phone:719-543-0000
Practice Address - Fax:719-543-4330
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8201223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics