Individual
LISENIA COLLAZO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
301 EXPLORER ST, GWINN, MI 49841-2813
(906) 346-4924
(906) 372-3230
Mailing address
301 EXPLORER ST, GWINN, MI 49841-2813
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2901600436
MI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/01/2019
Last updated
10/29/2024
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