Provider Demographics
NPI:1598028672
Name:COLBERT, JAMES ERNEST III (DDS)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ERNEST
Last Name:COLBERT
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:122 OLD MULBERRY RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37334-7044
Mailing Address - Country:US
Mailing Address - Phone:931-993-6611
Mailing Address - Fax:
Practice Address - Street 1:1813 WILSON PKWY
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37334-3546
Practice Address - Country:US
Practice Address - Phone:931-433-5914
Practice Address - Fax:931-433-7481
Is Sole Proprietor?:No
Enumeration Date:2012-06-22
Last Update Date:2012-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9527122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist