Provider Demographics
NPI:1417016627
Name:COLLINS, ROBERT JONAS (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JONAS
Last Name:COLLINS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 SHENANDOAH VILLAGE DRIVE
Mailing Address - Street 2:SUITE 122
Mailing Address - City:WAYNESBORO
Mailing Address - State:VA
Mailing Address - Zip Code:22980
Mailing Address - Country:US
Mailing Address - Phone:540-949-5333
Mailing Address - Fax:540-942-9155
Practice Address - Street 1:920 SHENANDOAH VILLAGE DR
Practice Address - Street 2:SUITE 122
Practice Address - City:WAYNESBORO
Practice Address - State:VA
Practice Address - Zip Code:22980-9279
Practice Address - Country:US
Practice Address - Phone:540-949-5333
Practice Address - Fax:540-942-9155
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1223S0112X1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAU67410Medicare UPIN