Healthcare Provider Details

I. General information

NPI: 1811096357
Provider Name (Legal Business Name): ROBERT M COLLINS D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 SKYLINE DR
WILMINGTON DE
19808-1772
US

IV. Provider business mailing address

5500 SKYLINE DR
WILMINGTON DE
19808-1772
US

V. Phone/Fax

Practice location:
  • Phone: 302-239-3655
  • Fax:
Mailing address:
  • Phone: 302-239-3655
  • 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:
Title or Position:
Credential:
Phone: