Provider Demographics
NPI:1336335199
Name:COLLINS, WILLIAM KEELAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:KEELAN
Last Name:COLLINS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:WILLIAM
Other - Middle Name:KEELAN
Other - Last Name:COLLINS
Other - Suffix:I
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:101 49TH ST NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-5232
Mailing Address - Country:US
Mailing Address - Phone:202-398-1877
Mailing Address - Fax:202-398-1877
Practice Address - Street 1:101 49TH ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-5232
Practice Address - Country:US
Practice Address - Phone:202-398-1877
Practice Address - Fax:202-398-1877
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-14
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN31701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice