Provider Demographics
NPI:1962638395
Name:COLLATZ, LAURA A (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:A
Last Name:COLLATZ
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 1:360 WEST ST STE 100
Mailing Address - Street 2:
Mailing Address - City:PITTSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27312-9448
Mailing Address - Country:US
Mailing Address - Phone:919-542-2712
Mailing Address - Fax:919-542-7279
Practice Address - Street 1:30 W SALISBURY ST
Practice Address - Street 2:
Practice Address - City:PITTSBORO
Practice Address - State:NC
Practice Address - Zip Code:27312-4140
Practice Address - Country:US
Practice Address - Phone:919-542-2712
Practice Address - Fax:919-542-7279
Is Sole Proprietor?:No
Enumeration Date:2009-05-29
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8779122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5913556Medicaid