Provider Demographics
NPI:1881770857
Name:COLLINS, KANDACE RENAE (DDS)
Entity type:Individual
Prefix:DR
First Name:KANDACE
Middle Name:RENAE
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 1:305A S BOSQUE ST
Mailing Address - Street 2:P.O. BOX 1576
Mailing Address - City:WHITNEY
Mailing Address - State:TX
Mailing Address - Zip Code:76692-2739
Mailing Address - Country:US
Mailing Address - Phone:254-694-3114
Mailing Address - Fax:254-694-7084
Practice Address - Street 1:305A S BOSQUE ST
Practice Address - Street 2:
Practice Address - City:WHITNEY
Practice Address - State:TX
Practice Address - Zip Code:76692-2739
Practice Address - Country:US
Practice Address - Phone:254-694-3114
Practice Address - Fax:254-694-7084
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX227091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG60413OtherCHIPS