Provider Demographics
NPI:1689765604
Name:COLLINS, RICHARD EDWARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:EDWARD
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:ROUTE 1
Mailing Address - Street 2:BOX 91-2
Mailing Address - City:TEAGUE
Mailing Address - State:TX
Mailing Address - Zip Code:75860
Mailing Address - Country:US
Mailing Address - Phone:254-739-3837
Mailing Address - Fax:
Practice Address - Street 1:RURAL ROUTE 2
Practice Address - Street 2:
Practice Address - City:TEAGUE
Practice Address - State:TX
Practice Address - Zip Code:75860
Practice Address - Country:US
Practice Address - Phone:254-739-3837
Practice Address - Fax:254-739-3837
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX94851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice