Provider Demographics
NPI:1457452047
Name:COLLINS, MARK WILLIAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:WILLIAM
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 1:12285 SCRIPPS POWAY PKWY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-6149
Mailing Address - Country:US
Mailing Address - Phone:858-536-8338
Mailing Address - Fax:858-536-8144
Practice Address - Street 1:12285 SCRIPPS POWAY PKWY
Practice Address - Street 2:SUITE 102
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-6149
Practice Address - Country:US
Practice Address - Phone:858-536-8338
Practice Address - Fax:858-536-8144
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA379901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice