Provider Demographics
NPI:1447091467
Name:COLLINS, CAROLYN EMILY (DDS)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:EMILY
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 1:4810 ASHLEY PARK LN APT 1416
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-3882
Mailing Address - Country:US
Mailing Address - Phone:704-910-9169
Mailing Address - Fax:
Practice Address - Street 1:9456 CHARLOTTE HWY STE 202
Practice Address - Street 2:
Practice Address - City:INDIAN LAND
Practice Address - State:SC
Practice Address - Zip Code:29707-7953
Practice Address - Country:US
Practice Address - Phone:803-674-4944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-04
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCDGD.10775122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist