Provider Demographics
NPI:1831407634
Name:T. LANCE COLLIER, D.M.D., L.L.C.
Entity type:Organization
Organization Name:T. LANCE COLLIER, D.M.D., L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TAYLOR
Authorized Official - Middle Name:LANCE
Authorized Official - Last Name:COLLIER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:706-494-2844
Mailing Address - Street 1:PO BOX 604
Mailing Address - Street 2:
Mailing Address - City:FORTSON
Mailing Address - State:GA
Mailing Address - Zip Code:31808-0604
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6801 RIVER RD
Practice Address - Street 2:BUILDING A, SUITE 200
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-3352
Practice Address - Country:US
Practice Address - Phone:706-494-2844
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-15
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0135141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty