Provider Demographics
NPI:1740935147
Name:COLLINS, JUSTIN PAUL (DDS, MBS)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:PAUL
Last Name:COLLINS
Suffix:
Gender:M
Credentials:DDS, MBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2412 N SALISBURY BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-2399
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2412 N SALISBURY BLVD STE A
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-2399
Practice Address - Country:US
Practice Address - Phone:443-210-3398
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-15
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17783122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist