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General NPI Number Information
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NPI Number | 1295805901
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Entity Type | Individual
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Provider Name | ERIC JAY MCCOLLUM DDS
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Gender | Male
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Dates
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Enumeration Date | 11/09/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3810 N ELM ST SUITE 201
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City | GREENSBORO
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State | NC
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Zip | 27455-2727
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Country | US
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Telephone | 336-545-4281
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Fax | 336-545-4263
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Provider Business Mailing Address
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Address Line | 3810 N ELM ST SUITE 201
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City | GREENSBORO
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State | NC
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Zip | 27455-2727
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Country | US
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Telephone | 336-545-4281
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Fax | 336-545-4263
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 5032
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License Number State | NC
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