Provider Demographics
NPI:1326018169
Name:COLLINS, RYAN CHARLIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:CHARLIE
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 1:1220 22ND ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:ANACORTES
Mailing Address - State:WA
Mailing Address - Zip Code:98221-2582
Mailing Address - Country:US
Mailing Address - Phone:360-293-5311
Mailing Address - Fax:360-293-5114
Practice Address - Street 1:1220 22ND ST
Practice Address - Street 2:SUITE C
Practice Address - City:ANACORTES
Practice Address - State:WA
Practice Address - Zip Code:98221-2582
Practice Address - Country:US
Practice Address - Phone:360-293-5311
Practice Address - Fax:360-293-5114
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA100861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice