NPIMap

Organization Active NPI

Colliver Dental Group, P.a.

  • General Practice Dentistry
  • Frederick, MD
National Provider Identifier
1013061563
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
9614 Issued in MD
Legal business name
COLLIVER DENTAL GROUP, P.A.
Practice address
2090 Old Farm Dr
Ste. B
Frederick, MD 21702-5400
Phone
(301) 662-5914
Fax
(301) 662-7340
NPI assigned
Jan 22, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Katherine Christine Colliver
Title
Business Manager
Phone
(301) 662-5914

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 9614 MD Primary

Addresses

Primary practice location

2090 Old Farm Dr
Ste. B
Frederick, MD 21702-5400

Mailing address

2090 Old Farm Dr
Ste. B
Frederick, MD 21702-5400
Phone (301) 662-5914

National Provider Directory

National Provider Directory

Locations

2090 Old Farm Dr
Ste B
Frederick, MD 21702
Phone (301) 662-5914

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169424000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1013061563",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2090 OLD FARM DR",
            "address_2": "STE. B",
            "city": "FREDERICK",
            "state": "MD",
            "postal_code": "217025400",
            "telephone_number": "301-662-5914",
            "fax_number": "301-662-7340"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2090 OLD FARM DR",
            "address_2": "STE. B",
            "city": "FREDERICK",
            "state": "MD",
            "postal_code": "217025400",
            "telephone_number": "301-662-5914",
            "fax_number": "301-662-7340"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLLIVER DENTAL GROUP, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-22",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "COLLIVER",
        "authorized_official_first_name": "KATHERINE",
        "authorized_official_middle_name": "CHRISTINE",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "301-662-5914",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MD",
            "license": "9614",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Frederick, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.