Provider Demographics
NPI:1902474521
Name:COLBY, ELIZABETH ANNETTE-MCDANIEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:ANNETTE-MCDANIEL
Last Name:COLBY
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 1:118 ALDEN RD
Mailing Address - Street 2:
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-4721
Mailing Address - Country:US
Mailing Address - Phone:508-994-2255
Mailing Address - Fax:
Practice Address - Street 1:20 CLINTON AVE
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:RI
Practice Address - Zip Code:02835-1204
Practice Address - Country:US
Practice Address - Phone:401-423-2110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-11
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18590391223G0001X
RIDEN035531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice