Provider Demographics
NPI:1346574043
Name:COLLINS, ANGELA (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:
Last Name:COLLINS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:MRS
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:COLLINS TRICARICO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2000 MERRICK AVENUE
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566
Mailing Address - Country:US
Mailing Address - Phone:516-379-4141
Mailing Address - Fax:
Practice Address - Street 1:2000 MERRICK AVENUE
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566
Practice Address - Country:US
Practice Address - Phone:516-379-4141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-28
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035224122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist