Provider Demographics
NPI:1982769444
Name:COLLINS, WILLIE F (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIE
Middle Name:F
Last Name:COLLINS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 E PRUDHOMME ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570-6458
Mailing Address - Country:US
Mailing Address - Phone:337-942-1007
Mailing Address - Fax:337-942-9684
Practice Address - Street 1:611 E PRUDHOMME ST
Practice Address - Street 2:SUITE 2
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-6458
Practice Address - Country:US
Practice Address - Phone:337-942-1007
Practice Address - Fax:337-942-9684
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1842656Medicaid