Provider Demographics
NPI:1043544299
Name:WOODSIDE, COLLINS (DDS)
Entity Type:Individual
Prefix:DR
First Name:COLLINS
Middle Name:
Last Name:WOODSIDE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:COLLINS
Other - Middle Name:WOODSIDE
Other - Last Name:GROSSMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:COLLINS GROSSMAN
Mailing Address - Street 1:1901 42ND AVE E
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98112-3232
Mailing Address - Country:US
Mailing Address - Phone:206-323-6555
Mailing Address - Fax:206-328-7046
Practice Address - Street 1:1901 42ND AVE E
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98112-3232
Practice Address - Country:US
Practice Address - Phone:206-323-6555
Practice Address - Fax:206-328-7046
Is Sole Proprietor?:No
Enumeration Date:2009-09-21
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA000082021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice