Provider Demographics
NPI:1871690388
Name:COLLINS, YVONNE MAURINE (DDS)
Entity Type:Individual
Prefix:
First Name:YVONNE
Middle Name:MAURINE
Last Name:COLLINS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 HERITAGE CIR
Mailing Address - Street 2:PAWNEE INDIAN HEALTH CENTER
Mailing Address - City:PAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74058-3744
Mailing Address - Country:US
Mailing Address - Phone:918-762-6561
Mailing Address - Fax:918-762-3543
Practice Address - Street 1:1201 HERITAGE CIR
Practice Address - Street 2:PAWNEE INDIAN HEALTH CENTER
Practice Address - City:PAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74058-3744
Practice Address - Country:US
Practice Address - Phone:918-762-6561
Practice Address - Fax:918-762-3543
Is Sole Proprietor?:No
Enumeration Date:2006-09-19
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4406122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100112090AMedicaid