Provider Demographics
NPI:1922302553
Name:COLLINS, TIMOTHY N (DDS)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:N
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 1:3808 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-3020
Mailing Address - Country:US
Mailing Address - Phone:619-295-2202
Mailing Address - Fax:619-295-2265
Practice Address - Street 1:3808 FRONT ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-3020
Practice Address - Country:US
Practice Address - Phone:619-295-2202
Practice Address - Fax:619-295-2265
Is Sole Proprietor?:No
Enumeration Date:2010-12-21
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA410051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice