Provider Demographics
NPI:1659463057
Name:MARK W. COLLINS.D.D.S.,INC.
Entity Type:Organization
Organization Name:MARK W. COLLINS.D.D.S.,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:858-536-8338
Mailing Address - Street 1:12285 SCRIPPS POWAY PKWY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-6149
Mailing Address - Country:US
Mailing Address - Phone:858-536-8338
Mailing Address - Fax:
Practice Address - Street 1:12285 SCRIPPS POWAY PKWY
Practice Address - Street 2:SUITE 102
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-6149
Practice Address - Country:US
Practice Address - Phone:858-536-8338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA379901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty