Provider Demographics
NPI:1467498048
Name:COLLARD, MARY CANDACE (DDS)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:CANDACE
Last Name:COLLARD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:M
Other - Middle Name:CANDACE
Other - Last Name:COLLARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:6490 MAIN STREET
Mailing Address - Street 2:SUITE #5
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5853
Mailing Address - Country:US
Mailing Address - Phone:716-633-6131
Mailing Address - Fax:716-633-0086
Practice Address - Street 1:6490 MAIN STREET
Practice Address - Street 2:SUITE #5
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5853
Practice Address - Country:US
Practice Address - Phone:716-633-6131
Practice Address - Fax:716-633-0086
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041122122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist