Provider Demographics
NPI:1922313808
Name:R. JONAS COLLINS, DMD, PC
Entity Type:Organization
Organization Name:R. JONAS COLLINS, DMD, PC
Other - Org Name:DR. ROBERT JONAS COLLINS, DMD
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE ADMINSITRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:WOOD
Authorized Official - Last Name:MOONEYHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-949-5333
Mailing Address - Street 1:920 SHENANDOAH VILLAGE DR
Mailing Address - Street 2:SUITE 122
Mailing Address - City:WAYNESBORO
Mailing Address - State:VA
Mailing Address - Zip Code:22980-9279
Mailing Address - Country:US
Mailing Address - Phone:540-949-5333
Mailing Address - Fax:540-942-9155
Practice Address - Street 1:920 SHENANDOAH VILLAGE DR
Practice Address - Street 2:SUITE 122
Practice Address - City:WAYNESBORO
Practice Address - State:VA
Practice Address - Zip Code:22980-9279
Practice Address - Country:US
Practice Address - Phone:540-949-5333
Practice Address - Fax:540-942-9155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-16
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04380001391223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty