# ALEXIS COLLINS CHILDRENS DENTISTRY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1851662274
- **Authorized official:** ALEXIS COLLINS (OWNER)
- **Authorized official phone:** (803) 772-7302

## Contact information

- **Practice address:** 392 SAINT ANDREWS RD, COLUMBIA, SC 29210-4427
- **Practice address phone:** (803) 772-7302
- **Practice address fax:** (803) 772-7353
- **Mailing address:** 1774 DUTCH FORK RD, IRMO, SC 29063-8829
- **Mailing address phone:** (803) 772-7302
- **Mailing address fax:** (803) 772-7353

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0221X | Pediatric Dentistry | 4507 | SC | Yes |

## Other

- **Enumeration date:** 01/17/2012
- **Last updated:** 12/30/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | Z17072 | — | SC |
| 05 | — | ZX4507 | — | SC |