Provider Demographics
NPI:1699189969
Name:COLLYMORE, PAGE (DMD)
Entity Type:Individual
Prefix:
First Name:PAGE
Middle Name:
Last Name:COLLYMORE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6322 DEMOCRACY BLVD
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-1664
Mailing Address - Country:US
Mailing Address - Phone:301-897-5880
Mailing Address - Fax:
Practice Address - Street 1:849 QUINCE ORCHARD BLVD
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-1678
Practice Address - Country:US
Practice Address - Phone:301-527-2725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-16
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-029809122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist