Provider Demographics
NPI:1699089003
Name:SYLVESTER, COLTON WAYNE (DMD)
Entity type:Individual
Prefix:DR
First Name:COLTON
Middle Name:WAYNE
Last Name:SYLVESTER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 S PROSPECT RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61704-4900
Mailing Address - Country:US
Mailing Address - Phone:309-662-2833
Mailing Address - Fax:
Practice Address - Street 1:405 S PROSPECT RD
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61704-4900
Practice Address - Country:US
Practice Address - Phone:309-662-2833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-28
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019028431122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist