Provider Demographics
NPI:1295775831
Name:COLLIER, KATHERINE GRANT (DDS)
Entity type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:GRANT
Last Name:COLLIER
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 1:1000 E EAGER ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-5533
Mailing Address - Country:US
Mailing Address - Phone:410-502-8656
Mailing Address - Fax:410-522-9808
Practice Address - Street 1:1000 E EAGER ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-5533
Practice Address - Country:US
Practice Address - Phone:410-502-8656
Practice Address - Fax:410-522-9808
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD76981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD449274900Medicaid
MD261864800Medicaid