Provider Demographics
NPI:1730172214
Name:COLLEY, H. BYRON III (DMD)
Entity type:Individual
Prefix:DR
First Name:H.
Middle Name:BYRON
Last Name:COLLEY
Suffix:III
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 1:5901 ABERCORN ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-5509
Mailing Address - Country:US
Mailing Address - Phone:912-355-5901
Mailing Address - Fax:912-355-0735
Practice Address - Street 1:5901 ABERCORN ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-5509
Practice Address - Country:US
Practice Address - Phone:912-355-5901
Practice Address - Fax:912-355-0735
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA123231223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZG2323Medicaid
GA800722OtherUNITED CONCORDIA I.D. #