Individual
DR. DREW ANTHONY COLANTINO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD, MS
Contact information
Practice address
997 CLOCK TOWER DR STE B, SPRINGFIELD, IL 62704-1399
(217) 546-9600
Mailing address
1212 ORENDORFF PKWY, SPRINGFIELD, IL 62704-2825
(217) 971-3062
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
019029230
IL
122300000X
Dentist
2901600326
MI
1223P0221X
Pediatric Dentistry
021.002987
IL
1223P0221X
Pediatric Dentistry
2901600326
MI
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
021.002996
IL
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
2901600326
MI
Other
Enumeration date
02/07/2013
Last updated
02/05/2020
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