Individual provider · NPI-1

Dr. Wallace Spurgeon Colvin III, D.D.S.

Dentist, General Practice · Mount Clemens, MI

NPI number1730247222
StatusActive
Last updated in NPPESJul 8, 2007

Details

NPI
1730247222
Entity type
Individual (NPI-1)
Name
Dr. Wallace Spurgeon Colvin III
Credential
D.D.S.
Sex
Male
Sole proprietor
No
Enumeration date
Dec 5, 2006
Last updated
Jul 8, 2007

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
1223G0001X Dentist, General Practice2901016347MIYes

Practice location

69 Southbound Gratiot Ave
Mount Clemens, MI 48043-5545

Phone 586-783-7000 · Fax 586-783-7003

Mailing address

69 Southbound Gratiot Ave
Mount Clemens, MI 48043-5545

Phone 586-783-7000 · Fax 586-783-7003

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