Provider Demographics
NPI:1316949282
Name:COLSON, CYNTHIA L (DMD)
Entity type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:L
Last Name:COLSON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 RAILROAD ST S
Mailing Address - Street 2:
Mailing Address - City:MC EWEN
Mailing Address - State:TN
Mailing Address - Zip Code:37101-4762
Mailing Address - Country:US
Mailing Address - Phone:931-582-6997
Mailing Address - Fax:931-582-6989
Practice Address - Street 1:161 RAILROAD ST S
Practice Address - Street 2:
Practice Address - City:MC EWEN
Practice Address - State:TN
Practice Address - Zip Code:37101-4762
Practice Address - Country:US
Practice Address - Phone:931-582-6997
Practice Address - Fax:931-582-6989
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD58781223S0112X
TNDS00000076811223S0112X
CA580531223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5440496Medicaid