Provider Demographics
NPI:1528132396
Name:COLOIAN, GARY MARTIN (DDS)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:MARTIN
Last Name:COLOIAN
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 1:29160 CENTER RIDGE SUITE G
Mailing Address - Street 2:
Mailing Address - City:WASTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145
Mailing Address - Country:US
Mailing Address - Phone:440-835-4380
Mailing Address - Fax:440-835-3647
Practice Address - Street 1:29160 CENTER RIDGE SUITE G
Practice Address - Street 2:
Practice Address - City:WASTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145
Practice Address - Country:US
Practice Address - Phone:440-835-4380
Practice Address - Fax:440-835-3647
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH18656122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist