Healthcare Provider Details

I. General information

NPI: 1306868401
Provider Name (Legal Business Name): COLLINS FAMILY DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2105 BROAD AVE STE E
LANETT AL
36863-3117
US

IV. Provider business mailing address

2105 BROAD AVE STE E
LANETT AL
36863
US

V. Phone/Fax

Practice location:
  • Phone: 334-642-2200
  • Fax:
Mailing address:
  • Phone: 334-642-2200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number4359
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number5480
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number4617
License Number StateAL
# 4
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number5836
License Number StateAL

VIII. Authorized Official

Name: DR. PAIGE J COLLINS
Title or Position: DENTIST
Credential: D.M.D.
Phone: 334-642-2200