Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 4507 | SC |
NPI | 1003062753 |
---|---|
Provider Name | Alexis Pickens Collins |
First Address | Columbia, SC 29210-4427 |
Second Address | Columbia, SC 29210-4427 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2008 |
Last Update Date | 28/12/2011 |