Provider Demographics
NPI:1376796706
Name:COLLINS, JAKE WESLEY (DDS,MS)
Entity Type:Individual
Prefix:
First Name:JAKE
Middle Name:WESLEY
Last Name:COLLINS
Suffix:
Gender:M
Credentials:DDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7300 FARM RD 2222
Mailing Address - Street 2:BUILDING V, SUITE 212
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78730-3204
Mailing Address - Country:US
Mailing Address - Phone:512-346-7668
Mailing Address - Fax:512-346-8300
Practice Address - Street 1:7300 FARM RD 2222
Practice Address - Street 2:BUILDING V, SUITE 212
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78730-3204
Practice Address - Country:US
Practice Address - Phone:512-346-7668
Practice Address - Fax:512-346-8300
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-29
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX238311223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics