# DR. KENNETH COLBERT DDS INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1174057178
- **Authorized official:** KENNETH COLBERT (PRESIDENT)
- **Authorized official phone:** (573) 775-2636

## Contact information

- **Practice address:** PO BOX AQ, 204 W MAIN ST, STEELVILLE, MO 65565-0609
- **Practice address phone:** (573) 775-2636
- **Mailing address:** PO BOX AQ, 204 W. MAIN ST, STEELVILLE, MO 65565-0609
- **Mailing address phone:** (573) 775-2636

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | 013305 | MO | Yes |

## Other

- **Enumeration date:** 04/17/2017
- **Last updated:** 04/17/2017