Healthcare Provider Details

I. General information

NPI: 1659452886
Provider Name (Legal Business Name): COLLINS & MONTZ, D.M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

524 OCEAN AVE
MELBOURNE BEACH FL
32951-2524
US

IV. Provider business mailing address

524 OCEAN AVE
MELBOURNE BEACH FL
32951-2524
US

V. Phone/Fax

Practice location:
  • Phone: 321-725-6565
  • Fax: 321-722-3871
Mailing address:
  • Phone: 321-725-6565
  • Fax: 321-722-3871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number14467
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number14275
License Number StateFL

VIII. Authorized Official

Name: DR. J. HUNTER COLLINS
Title or Position: DOCTOR
Credential: D.M.D.
Phone: 321-725-6565