Healthcare Provider Details

I. General information

NPI: 1790990927
Provider Name (Legal Business Name): KATHERINE G. COLLIER D.D.S., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 11/10/2021
Certification Date: 11/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E EAGER STREET
BALTIMORE MD
21202-5533
US

IV. Provider business mailing address

1000 E EAGER ST
BALTIMORE MD
21202-5533
US

V. Phone/Fax

Practice location:
  • Phone: 410-502-8565
  • Fax:
Mailing address:
  • Phone: 410-502-8565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7698
License Number StateMD

VIII. Authorized Official

Name: SHEILA R TURNER JOHNSON
Title or Position: BUSINESS MANAGER
Credential:
Phone: 410-541-4432