Provider Demographics
NPI:1326358680
Name:COLLINS DENTISTRY FOR CHILDREN
Entity Type:Organization
Organization Name:COLLINS DENTISTRY FOR CHILDREN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:NOLET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-635-1166
Mailing Address - Street 1:76 ALLDS ST STE 5
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03060-4704
Mailing Address - Country:US
Mailing Address - Phone:603-718-8587
Mailing Address - Fax:603-718-8592
Practice Address - Street 1:76 ALLDS ST STE 5
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-4704
Practice Address - Country:US
Practice Address - Phone:603-718-8587
Practice Address - Fax:603-718-8592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-20
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH32141223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30313756Medicaid