Provider Demographics
NPI:1881615441
Name:COLLIER, MICHELE ELIZABETH (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:ELIZABETH
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 1:609 ATTAIN ST STE 191
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-1972
Mailing Address - Country:US
Mailing Address - Phone:919-557-5250
Mailing Address - Fax:
Practice Address - Street 1:609 ATTAIN ST STE 191
Practice Address - Street 2:
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526-1972
Practice Address - Country:US
Practice Address - Phone:919-557-5250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC79031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5900852Medicaid