Healthcare Provider Details

I. General information

NPI: 1700491545
Provider Name (Legal Business Name): COLLINS ORTHODONTICS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2020
Last Update Date: 03/23/2021
Certification Date: 03/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2946 JEREMIAH LN NW
ROCHESTER MN
55901-4445
US

IV. Provider business mailing address

2946 JEREMIAH LN NW
ROCHESTER MN
55901-4445
US

V. Phone/Fax

Practice location:
  • Phone: 507-258-5400
  • Fax:
Mailing address:
  • Phone: 507-258-5400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. GRANT CONRAD COLLINS
Title or Position: ORTHODONTIST, OWNER
Credential: DDS, MS
Phone: 507-258-5400