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General NPI Number Information
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NPI Number | 1487087508
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Entity Type | Individual
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Provider Name | STEPHANIE LYNN SO COLLINS D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 08/12/2013
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Last Update Date | 07/13/2022
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Provider Practice Location Address
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Address Line | 100 WOODS CIR STE 600
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City | ALPENA
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State | MI
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Zip | 49707-1445
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Country | US
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Telephone | 989-356-4898
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Fax |
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Provider Business Mailing Address
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Address Line | 904 N BEAVER ST
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City | FLAGSTAFF
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State | AZ
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Zip | 86001-3108
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Country | US
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Telephone | 928-853-6068
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Fax |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | D008824
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 2901601287
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License Number State | MI
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