Provider Demographics
NPI:1467476986
Name:COLLINS, TIMOTHY ERVIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:ERVIN
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:PO BOX 2346
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24212-2346
Mailing Address - Country:US
Mailing Address - Phone:276-608-8608
Mailing Address - Fax:276-619-5100
Practice Address - Street 1:616 CAMPUS DRIVE
Practice Address - Street 2:STE 100
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210
Practice Address - Country:US
Practice Address - Phone:276-619-5020
Practice Address - Fax:276-619-5100
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2019-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401007964122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1321074OtherUNITED CONCORDIA
267057OtherBCBS ANTHEM
VA008200041Medicaid