Provider Demographics
NPI:1366575193
Name:COLTER, LINDA KAY (DDS)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:KAY
Last Name:COLTER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:803 W NATIONAL AVE
Mailing Address - Street 2:
Mailing Address - City:BRAZIL
Mailing Address - State:IN
Mailing Address - Zip Code:47834-2437
Mailing Address - Country:US
Mailing Address - Phone:812-446-2275
Mailing Address - Fax:812-446-6038
Practice Address - Street 1:803 W NATIONAL AVE
Practice Address - Street 2:
Practice Address - City:BRAZIL
Practice Address - State:IN
Practice Address - Zip Code:47834-2437
Practice Address - Country:US
Practice Address - Phone:812-446-2275
Practice Address - Fax:812-446-6038
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009712A1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics