Zachary Scott Colclasure, D.M.D
Individual provider Active NPI Dentist · Warren, IN
NPI 1154770717 · NPPES record last updated Jun 5, 2016
Key facts
- NPI
- 1154770717
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 12012512A (IN)
- Practice address
- 470 Bennett Dr Ste a
Warren, IN 46792-9273 - Phone
- (260) 375-2626
- NPI assigned
- Jun 5, 2016
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160719001970 | IN | Order and Referring Only - Dentist |
6800189481 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12012512A | IN | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 12012512A | IN | Yes |
Addresses
Primary practice location
470 Bennett Dr Ste a
Warren, IN 46792-9273
Mailing address
470 Bennett Dr Ste a
Warren, IN 46792-9273
Phone (260) 375-2626
Other providers in Warren, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 5, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.