Provider Demographics
NPI:1306527478
Name:COLVIN, NICHOLAS B (DDS)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:B
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 1:1091 BARBER CREEK RD
Mailing Address - Street 2:
Mailing Address - City:STATHAM
Mailing Address - State:GA
Mailing Address - Zip Code:30666-3153
Mailing Address - Country:US
Mailing Address - Phone:770-855-4434
Mailing Address - Fax:
Practice Address - Street 1:1091 BARBER CREEK RD
Practice Address - Street 2:
Practice Address - City:STATHAM
Practice Address - State:GA
Practice Address - Zip Code:30666-3153
Practice Address - Country:US
Practice Address - Phone:678-325-8912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC132011223X0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0008XDental ProvidersDentistOral and Maxillofacial Radiology