Mark Steven Colburn, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN10895 Issued in FL

Practice address

1300 13TH St
Suite B
Saint Cloud, FL 34769-4317

Phone

(407) 892-3326

Fax

(407) 892-4354

NPI assigned

Dec 20, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Family Dentistry of St. Cloud, PL

  • General Practice Dentistry
  • Saint Cloud, FL
  • NPI 1669796264
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166572800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1851455539",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 13TH ST",
            "address_2": "SUITE B",
            "city": "SAINT CLOUD",
            "state": "FL",
            "postal_code": "347694317",
            "telephone_number": "407-892-3326",
            "fax_number": "407-892-4354"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 13TH ST",
            "address_2": "SUITE B",
            "city": "SAINT CLOUD",
            "state": "FL",
            "postal_code": "347694317",
            "telephone_number": "407-892-3326",
            "fax_number": "407-892-4354"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COLBURN",
        "first_name": "MARK",
        "middle_name": "STEVEN",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-20",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN10895",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "915525",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "36902",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Andres Enrique Colberg
• Sharon Elizabeth Cole, DPT
• Vanessa Coleman
• Bebalinez Collazo Montes
• Lilialis Collazo Yambo, APRN
• Bonnie J Collins

• General Practice Dentistry in Saint Cloud, FL
• Providers in Saint Cloud, FL by specialty
• General Practice Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.