Provider Demographics
NPI:1700154507
Name:COLLINS, MONTE K (DDS, MSD)
Entity Type:Individual
Prefix:
First Name:MONTE
Middle Name:K
Last Name:COLLINS
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 CENTRAL DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-5884
Mailing Address - Country:US
Mailing Address - Phone:817-283-3777
Mailing Address - Fax:817-283-6929
Practice Address - Street 1:2121 CENTRAL DR
Practice Address - Street 2:SUITE 2
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-5884
Practice Address - Country:US
Practice Address - Phone:817-283-3777
Practice Address - Fax:817-283-6929
Is Sole Proprietor?:No
Enumeration Date:2011-12-07
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX147101223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics