Provider Demographics
NPI:1215483854
Name:WINDOM, COLIN THOMAS (DDS)
Entity type:Individual
Prefix:DR
First Name:COLIN
Middle Name:THOMAS
Last Name:WINDOM
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 1:112 DELMAR STREET
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:CO
Mailing Address - Zip Code:80751
Mailing Address - Country:US
Mailing Address - Phone:970-522-5535
Mailing Address - Fax:
Practice Address - Street 1:112 DELMAR STREET
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:CO
Practice Address - Zip Code:80751-4138
Practice Address - Country:US
Practice Address - Phone:970-522-5535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO002029361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice