Individual
DR. WALTER COLLAZO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
1614 VILLAGE MARKET BLVD SE STE 100, LEESBURG, VA 20175-5113
(703) 777-8777
(703) 777-6901
Mailing address
1614 VILLAGE MARKET BLVD SE STE 100, LEESBURG, VA 20175-5113
(703) 777-8777
(703) 777-6901
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
0401008551
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
452873
BLUE CROSS BLUE SHIELD
VA
Enumeration date
10/13/2006
Last updated
07/07/2025
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