Individual
COLTON CHARLES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
450 W STATE ST STE 180, EAGLE, ID 83616-6974
(208) 939-0600
Mailing address
450 W STATE ST STE 180, EAGLE, ID 83616-6974
(208) 939-0600
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D4320
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D-4320
STATE LICENSE
ID
Enumeration date
07/22/2010
Last updated
06/17/2020
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