Provider Demographics
NPI:1316096134
Name:COLON-DEGLANS, JOSE O (DMD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:O
Last Name:COLON-DEGLANS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:576 CALLE CESAR GONZALEZ STE 308
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-3757
Mailing Address - Country:US
Mailing Address - Phone:787-764-5100
Mailing Address - Fax:787-764-0159
Practice Address - Street 1:576 CALLE CESAR GONZALEZ STE 308
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3757
Practice Address - Country:US
Practice Address - Phone:787-764-5100
Practice Address - Fax:787-764-0159
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR19831223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics