Provider Demographics
NPI:1245891597
Name:COLLINS, BRENT ANDREW (DDS)
Entity type:Individual
Prefix:
First Name:BRENT
Middle Name:ANDREW
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 1:4724 BILL SIMMONS RD
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-4331
Mailing Address - Country:US
Mailing Address - Phone:817-991-3883
Mailing Address - Fax:
Practice Address - Street 1:1301 W GLADE RD STE 110
Practice Address - Street 2:
Practice Address - City:EULESS
Practice Address - State:TX
Practice Address - Zip Code:76039-5419
Practice Address - Country:US
Practice Address - Phone:817-358-2008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-27
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX354071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice