Provider Demographics
NPI:1609499300
Name:DUDZINSKI, COLIN BLAIR (DDS)
Entity type:Individual
Prefix:DR
First Name:COLIN
Middle Name:BLAIR
Last Name:DUDZINSKI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3423 S 72ND ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-3573
Mailing Address - Country:US
Mailing Address - Phone:402-341-5306
Mailing Address - Fax:402-346-1905
Practice Address - Street 1:3423 S 72ND ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-3573
Practice Address - Country:US
Practice Address - Phone:402-341-5306
Practice Address - Fax:402-346-1905
Is Sole Proprietor?:No
Enumeration Date:2020-05-28
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE76111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice