Provider Demographics
NPI:1033445309
Name:STEVEN D COLLINS, DDS
Entity Type:Organization
Organization Name:STEVEN D COLLINS, DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:S
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-292-4321
Mailing Address - Street 1:11700 HAYMARKET AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6009
Mailing Address - Country:US
Mailing Address - Phone:225-292-4321
Mailing Address - Fax:225-292-0584
Practice Address - Street 1:11700 HAYMARKET AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-6009
Practice Address - Country:US
Practice Address - Phone:225-292-4321
Practice Address - Fax:225-292-0584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-21
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA29111223G0001X
LALA53961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA844912OtherUNITED CONCORDIA
LAF1249OtherBLUE CROSS BLUE SHIELD