Provider Demographics
NPI:1427074152
Name:DELACY, COLLEEN BESS (DDS)
Entity type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:BESS
Last Name:DELACY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3990 BEDFORD RD
Mailing Address - Street 2:
Mailing Address - City:FORT GRATIOT
Mailing Address - State:MI
Mailing Address - Zip Code:48059-4004
Mailing Address - Country:US
Mailing Address - Phone:810-966-0611
Mailing Address - Fax:
Practice Address - Street 1:30 DAWSON ST
Practice Address - Street 2:BOX 231
Practice Address - City:SANDUSKY
Practice Address - State:MI
Practice Address - Zip Code:48471-1032
Practice Address - Country:US
Practice Address - Phone:810-648-4740
Practice Address - Fax:840-648-4796
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010186031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice