Provider Demographics
NPI:1427788090
Name:MILDRED COLLAZO DDS PL
Entity type:Organization
Organization Name:MILDRED COLLAZO DDS PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MILDRED
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLAZO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:561-294-4796
Mailing Address - Street 1:3930 NW 72ND DR
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-2248
Mailing Address - Country:US
Mailing Address - Phone:561-294-4796
Mailing Address - Fax:
Practice Address - Street 1:5863 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-4617
Practice Address - Country:US
Practice Address - Phone:954-720-2444
Practice Address - Fax:954-364-8548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-15
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty