Individual
DR. JENNIFER DIANE COLTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
5211 FOREST LN STE 127, DALLAS, TX 75244-8038
(972) 233-4439
Mailing address
5211 FOREST LN STE 127, DALLAS, TX 75244-8038
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
20111
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0033BT
BLUE CROSS BLUE SHIELD #
TX
05
—
1747685
—
TX
01
—
G60008-1
CHIP PROVIDER NUMBER
TX
Enumeration date
01/08/2007
Last updated
07/09/2007
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