Provider Demographics
NPI:1336407022
Name:ADAIRA COLLINS DDS, LLC
Entity Type:Organization
Organization Name:ADAIRA COLLINS DDS, LLC
Other - Org Name:DENTAL ELEMENTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAIRA
Authorized Official - Middle Name:J
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:256-684-3382
Mailing Address - Street 1:8141 HIGHWAY 72 W
Mailing Address - Street 2:STE G
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-9569
Mailing Address - Country:US
Mailing Address - Phone:256-263-4383
Mailing Address - Fax:800-340-9450
Practice Address - Street 1:8141 HIGHWAY 72 W
Practice Address - Street 2:STE G
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-9569
Practice Address - Country:US
Practice Address - Phone:256-263-4383
Practice Address - Fax:800-340-9450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-01
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL56521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty