Provider Demographics
NPI:1073727772
Name:COLLINS, JOBY DAVIS (DMD)
Entity Type:Individual
Prefix:
First Name:JOBY
Middle Name:DAVIS
Last Name:COLLINS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 205
Mailing Address - Street 2:
Mailing Address - City:SMITHVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38870-0205
Mailing Address - Country:US
Mailing Address - Phone:662-651-7111
Mailing Address - Fax:662-651-7115
Practice Address - Street 1:60024 OLIVE ST
Practice Address - Street 2:
Practice Address - City:SMITHVILLE
Practice Address - State:MS
Practice Address - Zip Code:38870-9719
Practice Address - Country:US
Practice Address - Phone:662-651-7111
Practice Address - Fax:662-651-7115
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2715-931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice