Provider Demographics
NPI:1467578468
Name:COLLINS, GARTH WILLIAM
Entity Type:Individual
Prefix:DR
First Name:GARTH
Middle Name:WILLIAM
Last Name:COLLINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 NATOMA ST
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-3009
Mailing Address - Country:US
Mailing Address - Phone:916-985-2550
Mailing Address - Fax:
Practice Address - Street 1:612 NATOMA ST
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-3009
Practice Address - Country:US
Practice Address - Phone:916-985-2550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33073122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist