Provider Demographics
NPI:1801938956
Name:DALE R COLLINS D.D.S., P.A.
Entity type:Organization
Organization Name:DALE R COLLINS D.D.S., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:DALE
Authorized Official - Middle Name:R
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:302-239-6125
Mailing Address - Street 1:5500 SKYLINE DR
Mailing Address - Street 2:SUITE 3
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-1772
Mailing Address - Country:US
Mailing Address - Phone:302-239-3655
Mailing Address - Fax:302-239-3661
Practice Address - Street 1:5500 SKYLINE DR
Practice Address - Street 2:SUITE 3
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-1772
Practice Address - Country:US
Practice Address - Phone:302-239-3655
Practice Address - Fax:302-239-3661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEG1-00007481223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE100034646Medicaid