Provider Demographics
NPI:1205859345
Name:COLLIAS, JOHN CHRISTOPHER (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CHRISTOPHER
Last Name:COLLIAS
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 1:45 EAST BEACH DRIVE, PANAMA CITY, FL, USA
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32401-5242
Mailing Address - Country:US
Mailing Address - Phone:850-785-5502
Mailing Address - Fax:
Practice Address - Street 1:45 EAST BEACH DRIVE, PANAMA CITY, FL, USA
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-3240
Practice Address - Country:US
Practice Address - Phone:850-501-0761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47704122300000X
FLDN16143122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist