Healthcare Provider Details

I. General information

NPI: 1295711570
Provider Name (Legal Business Name): FELIX ROBERT COLLARD DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/19/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11587 HIGHWAY 180 E
SILVER CITY NM
88061-7780
US

IV. Provider business mailing address

PO BOX 4048
SILVER CITY NM
88062-4048
US

V. Phone/Fax

Practice location:
  • Phone: 505-388-1961
  • Fax: 505-388-1964
Mailing address:
  • Phone: 505-388-1961
  • Fax: 505-388-1964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number1063
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: