Healthcare Provider Details

I. General information

NPI: 1629379805
Provider Name (Legal Business Name): ROBERT M COLLINS DDS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2010
Last Update Date: 11/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 SKYLINE DR SUITE 3
WILMINGTON DE
19808-1772
US

IV. Provider business mailing address

5500 SKYLINE DR SUITE 3
WILMINGTON DE
19808
US

V. Phone/Fax

Practice location:
  • Phone: 302-239-3656
  • Fax:
Mailing address:
  • Phone: 302-239-3656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberG1-0001146
License Number StateDE

VIII. Authorized Official

Name: DR. ROBERT M COLLINS
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 302-239-3656