Provider Demographics
NPI:1023193174
Name:DOLLENS, CLYDE COLLOM (DDS)
Entity Type:Individual
Prefix:DR
First Name:CLYDE
Middle Name:COLLOM
Last Name:DOLLENS
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 1:12607 JONES RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-4840
Mailing Address - Country:US
Mailing Address - Phone:281-469-6281
Mailing Address - Fax:281-469-6291
Practice Address - Street 1:12607 JONES RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-4840
Practice Address - Country:US
Practice Address - Phone:281-469-6281
Practice Address - Fax:281-469-6291
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX108071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
11963OtherUNITED CONCORDIA