Healthcare Provider Details

I. General information

NPI: 1881770857
Provider Name (Legal Business Name): KANDACE RENAE COLLINS D.D.S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305A S BOSQUE ST
WHITNEY TX
76692-2739
US

IV. Provider business mailing address

305A S BOSQUE ST P.O. BOX 1576
WHITNEY TX
76692-2739
US

V. Phone/Fax

Practice location:
  • Phone: 254-694-3114
  • Fax: 254-694-7084
Mailing address:
  • Phone: 254-694-3114
  • Fax: 254-694-7084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number22709
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: