Provider Demographics
NPI:1093829673
Name:COLLIER, DONALD FREDRICK (DDS)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:FREDRICK
Last Name:COLLIER
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 1:1755 W HAMMER LN STE 4
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95209-2900
Mailing Address - Country:US
Mailing Address - Phone:209-952-7843
Mailing Address - Fax:209-954-9418
Practice Address - Street 1:1755 W HAMMER LN STE 4
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95209-2900
Practice Address - Country:US
Practice Address - Phone:209-952-7843
Practice Address - Fax:209-954-9418
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29244122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist