Provider Demographics
NPI:1720649668
Name:COLLINS, MATTHEW STEVEN (DMD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:STEVEN
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 1:1759 VIA PAJARO
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93012-4086
Mailing Address - Country:US
Mailing Address - Phone:805-415-0345
Mailing Address - Fax:
Practice Address - Street 1:1055 VALLEY RIVER WAY
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2159
Practice Address - Country:US
Practice Address - Phone:541-255-2205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-21
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD11074122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty