Provider Demographics
NPI:1053497818
Name:COLLINS, LYNN MARIE (DDS)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:MARIE
Last Name:COLLINS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 PEOPLES PLZ
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-4727
Mailing Address - Country:US
Mailing Address - Phone:302-834-4000
Mailing Address - Fax:
Practice Address - Street 1:38 PEOPLES PLZ
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-4727
Practice Address - Country:US
Practice Address - Phone:302-834-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEG5-00009781223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000901808Medicaid