Provider Demographics
NPI:1659411957
Name:COLLINS DENTAL LLC
Entity Type:Organization
Organization Name:COLLINS DENTAL LLC
Other - Org Name:COLLINS DENTAL ASSOCIATES
Other - Org Type:Other Name
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:302-834-4000
Mailing Address - Street 1:38 PEOPLES PLZ
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-4727
Mailing Address - Country:US
Mailing Address - Phone:302-834-4000
Mailing Address - Fax:302-834-1417
Practice Address - Street 1:38 PEOPLES PLZ
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-4727
Practice Address - Country:US
Practice Address - Phone:302-834-4000
Practice Address - Fax:302-834-1417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000970831Medicaid