Provider Demographics
NPI:1508830290
Name:COLLINS, TERI SUE (RDH)
Entity Type:Individual
Prefix:MRS
First Name:TERI
Middle Name:SUE
Last Name:COLLINS
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 WEST LOWDER STREET
Mailing Address - Street 2:
Mailing Address - City:MACCLENNY
Mailing Address - State:FL
Mailing Address - Zip Code:32063
Mailing Address - Country:US
Mailing Address - Phone:904-259-6291
Mailing Address - Fax:904-259-1950
Practice Address - Street 1:480 WEST LOWDER STREET
Practice Address - Street 2:
Practice Address - City:MACCLENNY
Practice Address - State:FL
Practice Address - Zip Code:32063
Practice Address - Country:US
Practice Address - Phone:904-259-6291
Practice Address - Fax:904-259-1950
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDH 9996124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist