Provider Demographics
NPI:1376648840
Name:DAVIDSON, COLLIN (DMD)
Entity Type:Individual
Prefix:DR
First Name:COLLIN
Middle Name:
Last Name:DAVIDSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4896 S 1900 W
Mailing Address - Street 2:SUITE C
Mailing Address - City:ROY
Mailing Address - State:UT
Mailing Address - Zip Code:84067-2994
Mailing Address - Country:US
Mailing Address - Phone:801-825-3898
Mailing Address - Fax:801-352-1872
Practice Address - Street 1:6087 S REDWOOD RD
Practice Address - Street 2:SUITE C
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84123-5330
Practice Address - Country:US
Practice Address - Phone:801-352-1300
Practice Address - Fax:801-352-1872
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5319871122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist