MEDICARE: RENEE AVA MCCOY-COLLINS D.D.S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	DEN3652	DC

General Provider Information

NPI Number	:	1679692214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENEE AVA MCCOY-COLLINS D.D.S

Provider Business Mailing Address
First Line	:	4708 BLAGDEN TER NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20011-3720
Country	:	US
Telephone Number	:	202-232-1116
Fax Number	:	202-232-1911

Provider Business Practice Location Address
First Line	:	2737 DEVONSHIRE PL NW STE A
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20008-3479
Country	:	US
Telephone Number	:	202-232-1116
Fax Number	:	202-232-1911

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2007
Last Update Date	:	06/26/2013

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