Provider Demographics
NPI:1881844413
Name:COLLINS, ELIZABETH K (DMD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:K
Last Name:COLLINS
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 1:342 MULE ACADEMY RD
Mailing Address - Street 2:
Mailing Address - City:FISHERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22939-2256
Mailing Address - Country:US
Mailing Address - Phone:540-932-5619
Mailing Address - Fax:
Practice Address - Street 1:342 MULE ACADEMY RD
Practice Address - Street 2:
Practice Address - City:FISHERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22939-2256
Practice Address - Country:US
Practice Address - Phone:540-932-5619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-18
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401008812122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist