MEDICARE: GEORGE G COLLINS III, DMD, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DN14039	FL

General Provider Information

NPI Number	:	1083823538
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GEORGE G COLLINS III, DMD, PA

Provider Business Mailing Address
First Line	:	1575 INDIAN RIVER BLVD
Second Line	:	SUITE C-140
City	:	VERO BEACH
State	:	FL
Zip	:	32960-5639
Country	:	US
Telephone Number	:	772-770-3246
Fax Number	:

Provider Business Practice Location Address
First Line	:	1575 INDIAN RIVER BLVD
Second Line	:	SUITE C-140
City	:	VERO BEACH
State	:	FL
Zip	:	32960-5639
Country	:	US
Telephone Number	:	772-770-3246
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. GEORGE G COLLINS III
Credential	:	DMD
Telephone Number	:	772-770-3246

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	08/22/2020

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