Provider Demographics
NPI:1538218334
Name:COLBURN, JEFFREY KEITH (DDS)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:KEITH
Last Name:COLBURN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3535 PARK ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49444-3736
Mailing Address - Country:US
Mailing Address - Phone:231-739-8047
Mailing Address - Fax:231-733-1472
Practice Address - Street 1:3535 PARK ST
Practice Address - Street 2:SUITE 100
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-3736
Practice Address - Country:US
Practice Address - Phone:231-739-8047
Practice Address - Fax:231-733-1472
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010121121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice