Provider Demographics
NPI:1457425944
Name:COLLINS, THOMAS J (DMD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:J
Last Name:COLLINS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 OLD LYME RD
Mailing Address - Street 2:
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534-3511
Mailing Address - Country:US
Mailing Address - Phone:585-385-4091
Mailing Address - Fax:
Practice Address - Street 1:43 WILLOW POND WAY
Practice Address - Street 2:SUITE 107
Practice Address - City:PENFIELD
Practice Address - State:NY
Practice Address - Zip Code:14526-2638
Practice Address - Country:US
Practice Address - Phone:585-421-8168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY03751711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice