Provider Demographics
NPI:1790901015
Name:COLLINS, BRIAN DARNELL (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:DARNELL
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:PO BOX 363
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05753-0363
Mailing Address - Country:US
Mailing Address - Phone:214-642-6383
Mailing Address - Fax:
Practice Address - Street 1:1330 EXCHANGE ST
Practice Address - Street 2:SUITE 107
Practice Address - City:MIDDLEBURY
Practice Address - State:VT
Practice Address - Zip Code:05753-4464
Practice Address - Country:US
Practice Address - Phone:214-642-6383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2014-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX141681223P0221X
VT016.00771841223P0221X
NH040221223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry