Provider Demographics
NPI:1801372495
Name:COLLINS, BENJAMIN HAMPTON (DMD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:HAMPTON
Last Name:COLLINS
Suffix:
Gender:M
Credentials:DMD
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 15128
Mailing Address - Street 2:
Mailing Address - City:SURFSIDE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29587-5128
Mailing Address - Country:US
Mailing Address - Phone:843-238-5111
Mailing Address - Fax:843-238-2412
Practice Address - Street 1:1616 AZALEA DR
Practice Address - Street 2:
Practice Address - City:SURFSIDE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29575-5277
Practice Address - Country:US
Practice Address - Phone:843-238-5111
Practice Address - Fax:843-238-2412
Is Sole Proprietor?:No
Enumeration Date:2018-07-17
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC92071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice