Individual
COLBY TERRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
600 N HIGHWAY 190 STE 4, COVINGTON, LA 70433-5083
(985) 893-5522
Mailing address
600 N HIGHWAY 190, COVINGTON, LA 70433-5003
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6911
LA
Other
Enumeration date
08/09/2018
Last updated
08/09/2018
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