Cynthia L Colson, D.M.D.
Individual provider Active NPI Oral and Maxillofacial Surgery (Dentist) · MC Ewen, TN
NPI 1316949282 · NPPES record last updated Feb 10, 2009
Key facts
- NPI
- 1316949282
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Oral and Maxillofacial Surgery (Dentist) 1223S0112X
- License
- D5878 (AZ)
- Practice address
- 161 Railroad St S
MC Ewen, TN 37101-4762 - Phone
- (931) 582-6997
- Fax
- (931) 582-6989
- NPI assigned
- Aug 11, 2005
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AZ
- 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 |
|---|---|---|---|---|
| I20161003001556 | AZ | Order and Referring Only - Oral Surgery |
4486941655 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D5878 | AZ | MD | Oral and Maxillofacial Surgery (Dentist) |
| 58053 | CA | MD | Oral and Maxillofacial Surgery (Dentist) |
| DS0000007681 | TN | MD | Oral and Maxillofacial Surgery (Dentist) |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| San Tan Oral Surgery | Current |
Accepting new patients | |
| McEwen Dental Specialities | Oral and Maxillofacial Surgery | Past | Accepting new patients |
| McEwen Dental Associates | Past | Accepting new patients |
Locations
3303 S Lindsay Rd
Ste 112
Gilbert, AZ 85297
Phone (480) 659-9820
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Oral and Maxillofacial Surgery (Dentist) | 1223S0112X | D5878 | AZ | Yes |
| Oral and Maxillofacial Surgery (Dentist) | 1223S0112X | DS0000007681 | TN | |
| Oral and Maxillofacial Surgery (Dentist) | 1223S0112X | 58053 | CA |
Addresses
Primary practice location
161 Railroad St S
MC Ewen, TN 37101-4762
Mailing address
161 Railroad St S
MC Ewen, TN 37101-4762
Phone (931) 582-6997
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5440496 | Medicaid | TN |
Other providers in MC Ewen, TN
- CDK LLC
- Juelda R Coleman
- Christy Michelle Dougherty
- Mary Elizabeth Ewing
- Family Health, LLC
- Herbison Medical Inc.
- Tracey Machell Hooper
All providers in MC Ewen, TN · Oral and Maxillofacial Surgery (Dentist) in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 10, 2009. 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.