Provider Demographics
NPI:1235219262
Name:COLLIER, DAVID C (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:C
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 1:612 LOCUST ST
Mailing Address - Street 2:SUITE #2
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-3718
Mailing Address - Country:US
Mailing Address - Phone:515-280-3030
Mailing Address - Fax:
Practice Address - Street 1:612 LOCUST ST
Practice Address - Street 2:SUITE #2
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-3718
Practice Address - Country:US
Practice Address - Phone:515-280-3030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA6370122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
42-1242080OtherFEDERAL TAX ID#
IA6370OtherIOWA LICENSE NUMBER
IA0159525OtherDELTA DENTAL ID#
IA0159525Medicaid