Provider Demographics
NPI:1487087508
Name:COLLINS, STEPHANIE LYNN SO (DDS)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:LYNN SO
Last Name:COLLINS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:904 N BEAVER ST
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-3108
Mailing Address - Country:US
Mailing Address - Phone:928-853-6068
Mailing Address - Fax:
Practice Address - Street 1:100 WOODS CIR STE 600
Practice Address - Street 2:
Practice Address - City:ALPENA
Practice Address - State:MI
Practice Address - Zip Code:49707-1445
Practice Address - Country:US
Practice Address - Phone:989-356-4898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-12
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD008824122300000X
MI2901601287122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist