Provider Demographics
NPI:1194366815
Name:COLLAZO, CAESAR (DDS)
Entity Type:Individual
Prefix:
First Name:CAESAR
Middle Name:
Last Name:COLLAZO
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 1:1303 SAN ANTONIO ST STE 500
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-0025
Mailing Address - Country:US
Mailing Address - Phone:512-879-6600
Mailing Address - Fax:
Practice Address - Street 1:1303 SAN ANTONIO ST STE 500
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701-0025
Practice Address - Country:US
Practice Address - Phone:512-879-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-03
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX197541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice