Healthcare Provider Details

I. General information

NPI: 1194456152
Provider Name (Legal Business Name): OLIVIA COLLINS DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2022
Last Update Date: 05/31/2023
Certification Date: 05/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 HICKORY RIDGE RD
HILLSBORO MO
63050-5100
US

IV. Provider business mailing address

227 MAIN ST
FESTUS MO
63028-1952
US

V. Phone/Fax

Practice location:
  • Phone: 636-481-6040
  • Fax: 636-797-5633
Mailing address:
  • Phone: 636-931-2700
  • Fax: 636-931-5304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2022019380
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: