Provider Demographics
NPI:1881192631
Name:COLLINS AND ASSOCIATES DDS PA
Entity Type:Organization
Organization Name:COLLINS AND ASSOCIATES DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:K
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:910-843-3353
Mailing Address - Street 1:PO BOX 112
Mailing Address - Street 2:
Mailing Address - City:RED SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:28377-0112
Mailing Address - Country:US
Mailing Address - Phone:910-843-3353
Mailing Address - Fax:910-843-7240
Practice Address - Street 1:714 E 4TH AVE
Practice Address - Street 2:
Practice Address - City:RED SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:28377-1669
Practice Address - Country:US
Practice Address - Phone:910-843-3353
Practice Address - Fax:910-843-7240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-26
Last Update Date:2018-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC86181223G0001X
NC93261223G0001X
NC82331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty