Provider Demographics
NPI:1922047182
Name:MCCOLLUM, JOSEPH ROBERT (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:ROBERT
Last Name:MCCOLLUM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17300 EL CAMINO REAL
Mailing Address - Street 2:SUITE 101A
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-2715
Mailing Address - Country:US
Mailing Address - Phone:281-488-8463
Mailing Address - Fax:281-488-9095
Practice Address - Street 1:17300 EL CAMINO REAL
Practice Address - Street 2:SUITE 101A
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-2715
Practice Address - Country:US
Practice Address - Phone:281-488-8463
Practice Address - Fax:281-488-9095
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12673122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist