Provider Demographics
NPI:1215077698
Name:COLVIN, DOUGLAS (DDS)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:
Last Name:COLVIN
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 1:9240 EXPLORER DR
Mailing Address - Street 2:SUITE110
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-5003
Mailing Address - Country:US
Mailing Address - Phone:719-599-0110
Mailing Address - Fax:
Practice Address - Street 1:9240 EXPLORER DR
Practice Address - Street 2:SUITE110
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-5003
Practice Address - Country:US
Practice Address - Phone:719-599-0110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6053122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist