Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 16005 | MD |
NPI | 1104123629 |
---|---|
Provider Name | Dr. Colin Trevor Galbraith |
First Address | Glenwood Springs, CO 81601-4270 |
Second Address | Glenwood Springs, CO 81601-4270 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/02/2011 |
Last Update Date | 04/02/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
16005 | MARYLAND STATE BOARD OF DENTAL EXAMINERS (01) | MD |
DEN.00204065 | COLORADO STATE BOARD OF DENTAL EXAMINERS (01) | CO |