Provider Demographics
NPI:1174720742
Name:COLLIER, TAYLOR LANCE (DMD)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:LANCE
Last Name:COLLIER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:706-494-2844
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:
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0135141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice