Healthcare Provider Details

I. General information

NPI: 1376463349
Provider Name (Legal Business Name): MCCOLLUM DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1498 KLONDIKE RD SW STE 201
CONYERS GA
30094-5169
US

IV. Provider business mailing address

1498 KLONDIKE RD SW STE 201
CONYERS GA
30094-5169
US

V. Phone/Fax

Practice location:
  • Phone: 770-922-7900
  • Fax:
Mailing address:
  • Phone: 770-922-7900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID MCCOLLUM
Title or Position: OWNER
Credential: DMD
Phone: 770-922-7900