Provider Demographics
NPI:1013954874
Name:COLLINS, JANNAS ETHELDRABROWN (DDS)
Entity Type:Individual
Prefix:
First Name:JANNAS
Middle Name:ETHELDRABROWN
Last Name: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 1:506 BYPASS 72 NORTHWEST
Mailing Address - Street 2:ASPEN DENTAL
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29649
Mailing Address - Country:US
Mailing Address - Phone:864-396-4200
Mailing Address - Fax:
Practice Address - Street 1:506 BYPASS 72
Practice Address - Street 2:ASPEN DENTAL
Practice Address - City:NORTHWEST, GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29649
Practice Address - Country:US
Practice Address - Phone:864-396-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2015-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC34951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZX3495Medicaid