Provider Demographics
NPI:1124385661
Name:COLLINS, DANIELLE (RDH)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:COLLINS
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 BLUE HILL AVE
Mailing Address - Street 2:
Mailing Address - City:MATTAPAN
Mailing Address - State:MA
Mailing Address - Zip Code:02126-2253
Mailing Address - Country:US
Mailing Address - Phone:617-296-0061
Mailing Address - Fax:617-296-8701
Practice Address - Street 1:1425 BLUE HILL AVE
Practice Address - Street 2:
Practice Address - City:MATTAPAN
Practice Address - State:MA
Practice Address - Zip Code:02126-2253
Practice Address - Country:US
Practice Address - Phone:617-296-0061
Practice Address - Fax:617-296-8701
Is Sole Proprietor?:No
Enumeration Date:2012-04-23
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADH87504124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist