Provider Demographics
NPI:1538376520
Name:COLLANTES, ANA MARIA (DDS)
Entity type:Individual
Prefix:
First Name:ANA MARIA
Middle Name:
Last Name:COLLANTES
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 1:44543 OVERLAND AVE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93536-6461
Mailing Address - Country:US
Mailing Address - Phone:661-723-5151
Mailing Address - Fax:661-272-8932
Practice Address - Street 1:510 W RANCHO VISTA BLVD
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-3737
Practice Address - Country:US
Practice Address - Phone:661-273-0706
Practice Address - Fax:661-273-3118
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA556581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice