Provider Demographics
NPI:1508867342
Name:COLLINS, THOMAS PETER (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:PETER
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 1:1303 W MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-2858
Mailing Address - Country:US
Mailing Address - Phone:330-497-7999
Mailing Address - Fax:330-497-1089
Practice Address - Street 1:1303 W MAPLE ST
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-2858
Practice Address - Country:US
Practice Address - Phone:330-497-7999
Practice Address - Fax:330-497-1089
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH15410122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist