Provider Demographics
NPI:1598285454
Name:MCCOLLOUGH, TREVOR (DMD)
Entity Type:Individual
Prefix:DR
First Name:TREVOR
Middle Name:
Last Name:MCCOLLOUGH
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 1:3531 E SUPERIOR ST
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55804-2043
Mailing Address - Country:US
Mailing Address - Phone:207-332-0028
Mailing Address - Fax:
Practice Address - Street 1:4707 E SUPERIOR ST
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55804-2339
Practice Address - Country:US
Practice Address - Phone:218-525-1921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-22
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDEN45721223G0001X
MND139181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice