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General NPI Number Information
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NPI Number | 1487938858
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Entity Type | Individual
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Provider Name | JOSEPH ROLLIN MCCOLLEY DDS
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Gender | Male
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Dates
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Enumeration Date | 10/04/2011
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Last Update Date | 12/31/2014
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Provider Practice Location Address
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Address Line | 642 VAL VISTA ST STUITE #A
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City | SHERIDAN
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State | WY
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Zip | 82801-3659
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Country | US
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Telephone | 307-746-5372
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Fax | 307-674-1765
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Provider Business Mailing Address
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Address Line | 642 VAL VISTA ST STUITE #A
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City | SHERIDAN
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State | WY
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Zip | 82801-3659
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Country | US
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Telephone | 307-746-5372
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Fax | 307-674-1765
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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 | 1281
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License Number State | WY
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