Provider Demographics
NPI:1275679672
Name:COLLADO, MYRNA LUZ (DDS)
Entity Type:Individual
Prefix:DR
First Name:MYRNA
Middle Name:LUZ
Last Name:COLLADO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3330 KINGMAN ST STE 6
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-4235
Mailing Address - Country:US
Mailing Address - Phone:504-888-2092
Mailing Address - Fax:504-888-7221
Practice Address - Street 1:3330 KINGMAN ST STE 6
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-4235
Practice Address - Country:US
Practice Address - Phone:504-888-2092
Practice Address - Fax:504-888-7221
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4540122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist