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General NPI Number Information
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NPI Number | 1629646096
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Entity Type | Individual
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Provider Name | AMANDA DICKERSON COLLIE DDS
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Gender | Female
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Dates
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Enumeration Date | 06/14/2021
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Last Update Date | 08/09/2022
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Provider Practice Location Address
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Address Line | 1000 E BROAD ST STE 200
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City | RICHMOND
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State | VA
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Zip | 23219-1930
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Country | US
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Telephone | 804-828-9095
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Fax |
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Provider Business Mailing Address
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Address Line | 5001 LIBBIE MILL EAST BLVD APT 508
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City | RICHMOND
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State | VA
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Zip | 23230-2146
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Country | US
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Telephone | 804-955-9068
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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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 | 0401417563
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License Number State | VA
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