Provider Demographics
NPI:1679692214
Name:MCCOY-COLLINS, RENEE AVA (DDS)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:AVA
Last Name:MCCOY-COLLINS
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 1:4708 BLAGDEN TER NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-3720
Mailing Address - Country:US
Mailing Address - Phone:202-232-1116
Mailing Address - Fax:202-232-1911
Practice Address - Street 1:2737 DEVONSHIRE PL NW STE A
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008-3479
Practice Address - Country:US
Practice Address - Phone:202-232-1116
Practice Address - Fax:202-232-1911
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN36521223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery