Individual
MARK COLLINSWORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RDH
Contact information
Practice address
160 MAIN ST, PENN YAN, NY 14527-1204
(315) 531-9102
Mailing address
601B W WASHINGTON ST, GENEVA, NY 14456-2119
(315) 787-8151
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
017629
NY
Other
Enumeration date
06/01/2018
Last updated
06/01/2018
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