Provider Demographics
NPI:1588660278
Name:COLLINS, BRYAN HOUSTON III (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:HOUSTON
Last Name:COLLINS
Suffix:III
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 1:10 CARE CIRCLE
Mailing Address - Street 2:SUITE B
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79124-2139
Mailing Address - Country:US
Mailing Address - Phone:806-356-9448
Mailing Address - Fax:806-356-9453
Practice Address - Street 1:10 CARE CIR
Practice Address - Street 2:UNIT B
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79124-2139
Practice Address - Country:US
Practice Address - Phone:806-356-9448
Practice Address - Fax:806-356-9453
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-27
Last Update Date:2007-07-08
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-03-23
Provider Licenses
StateLicense IDTaxonomies
TX166901223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics