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General NPI Number Information
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NPI Number | 1114338514
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Entity Type | Organization
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Legal Business Name | LUIS MIGUEL COLLAZOS ESCALANTE DDS INC
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Dates
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Enumeration Date | 05/19/2014
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Last Update Date | 05/19/2014
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Provider Practice Location Address
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Address Line | 116 H ST
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City | BAKERSFIELD
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State | CA
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Zip | 93304-2910
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Country | US
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Telephone | 661-327-2155
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Fax |
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Provider Business Mailing Address
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Address Line | 116 H ST
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City | BAKERSFIELD
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State | CA
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Zip | 93304-2910
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Country | US
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Telephone | 661-327-2155
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | LUIS MIGUEL COLLAZOS
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Credential | D.D.S
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Telephone | 661-327-2155
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 60923
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License Number State | CA
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