Healthcare Provider Details

I. General information

NPI: 1801938956
Provider Name (Legal Business Name): DALE R COLLINS D.D.S., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 06/16/2008
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
19808-1772
US

V. Phone/Fax

Practice location:
  • Phone: 302-239-3655
  • Fax: 302-239-3661
Mailing address:
  • Phone: 302-239-3655
  • Fax: 302-239-3661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberG1-0000748
License Number StateDE

VIII. Authorized Official

Name: DALE R COLLINS
Title or Position: DENTIST
Credential: D.D.S.
Phone: 302-239-6125