Provider Demographics
NPI:1679636922
Name:COLLINS, MICHAEL PAUL (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:PAUL
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 1:3102 WEST WATERS AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-2875
Mailing Address - Country:US
Mailing Address - Phone:813-933-8282
Mailing Address - Fax:813-933-6792
Practice Address - Street 1:3102 WEST WATERS AVE
Practice Address - Street 2:STE 101
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-2875
Practice Address - Country:US
Practice Address - Phone:813-933-8282
Practice Address - Fax:813-933-6792
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5454122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist