Provider Demographics
NPI:1083823538
Name:GEORGE G COLLINS III, DMD, PA
Entity Type:Organization
Organization Name:GEORGE G COLLINS III, DMD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:G
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:III
Authorized Official - Credentials:DMD
Authorized Official - Phone:772-770-3246
Mailing Address - Street 1:1575 INDIAN RIVER BLVD
Mailing Address - Street 2:SUITE C-140
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-5639
Mailing Address - Country:US
Mailing Address - Phone:772-770-3246
Mailing Address - Fax:
Practice Address - Street 1:1575 INDIAN RIVER BLVD
Practice Address - Street 2:SUITE C-140
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-5639
Practice Address - Country:US
Practice Address - Phone:772-770-3246
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN14039122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty