Provider Demographics
NPI:1346212529
Name:COLLINS, DAVID GLENN (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:GLENN
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 1:1555 S WADSWORTH BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80232-6832
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:303-986-1869
Practice Address - Street 1:1555 S WADSWORTH BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80232-6832
Practice Address - Country:US
Practice Address - Phone:303-986-9522
Practice Address - Fax:303-986-1869
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO70641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice