Provider Demographics
NPI:1720044100
Name:COLON, EVELYN (DMD)
Entity type:Individual
Prefix:MRS
First Name:EVELYN
Middle Name:
Last Name:COLON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5900 LYONS AVE
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77020-4808
Mailing Address - Country:US
Mailing Address - Phone:281-501-7550
Mailing Address - Fax:
Practice Address - Street 1:5900 LYONS AVE
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77020-4808
Practice Address - Country:US
Practice Address - Phone:281-501-7550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2020-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31878122300000X
PR22661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX752518300Medicaid
PR206252Medicare UPIN
PRD000113Medicare UPIN
PR8477Medicare UPIN
PR7690004Medicare UPIN