Provider Demographics
NPI:1053323816
Name:COLLINS, RICHARD THOMAS (DDS)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:THOMAS
Last Name:COLLINS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3838 70TH STREET
Mailing Address - Street 2:SUITE 102
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50322-3211
Mailing Address - Country:US
Mailing Address - Phone:515-276-6539
Mailing Address - Fax:515-276-7769
Practice Address - Street 1:3838 70TH STREET
Practice Address - Street 2:SUITE 102
Practice Address - City:URBANDALE
Practice Address - State:IA
Practice Address - Zip Code:50322-3211
Practice Address - Country:US
Practice Address - Phone:515-276-6539
Practice Address - Fax:515-276-7769
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA5558122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist