Provider Demographics
NPI:1487938858
Name:MCCOLLEY, JOSEPH ROLLIN (DDS)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:ROLLIN
Last Name:MCCOLLEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:642 VAL VISTA ST
Mailing Address - Street 2:STUITE #A
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-3659
Mailing Address - Country:US
Mailing Address - Phone:307-746-5372
Mailing Address - Fax:307-674-1765
Practice Address - Street 1:642 VAL VISTA ST
Practice Address - Street 2:STUITE #A
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-3659
Practice Address - Country:US
Practice Address - Phone:307-746-5372
Practice Address - Fax:307-674-1765
Is Sole Proprietor?:No
Enumeration Date:2011-10-04
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY1281122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist