Provider Demographics
NPI:1003062753
Name:COLLINS, ALEXIS PICKENS (DMD)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:PICKENS
Last Name:COLLINS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1774 DUTCH FORK RD
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-8829
Mailing Address - Country:US
Mailing Address - Phone:803-772-7302
Mailing Address - Fax:803-772-7353
Practice Address - Street 1:1774 DUTCH FORK RD
Practice Address - Street 2:
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-8829
Practice Address - Country:US
Practice Address - Phone:803-772-7302
Practice Address - Fax:803-772-7353
Is Sole Proprietor?:No
Enumeration Date:2008-08-13
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC45071223P0221X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist