Provider Demographics
NPI:1588784052
Name:SCHOLZ, COLLEEN JOYCE (COLLEEN SCHOLZ)
Entity type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:JOYCE
Last Name:SCHOLZ
Suffix:
Gender:F
Credentials:COLLEEN SCHOLZ
Other - Prefix:DR
Other - First Name:COLLEEN
Other - Middle Name:JOYCE
Other - Last Name:SHICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:222 PINE ST
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-2432
Mailing Address - Country:US
Mailing Address - Phone:970-484-1245
Mailing Address - Fax:
Practice Address - Street 1:222 PINE ST
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-2432
Practice Address - Country:US
Practice Address - Phone:970-484-1245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8549122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist