Healthcare Provider Details

I. General information

NPI: 1134117252
Provider Name (Legal Business Name): BOBBY MCMANUS COLLINS II DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 12/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1851 MACGREGOR DOWNS RD EAST CAROLINA UNIVERSITY SCHOOL OF DENTAL MEDICINE
GREENVILLE NC
27834-5925
US

IV. Provider business mailing address

2008 CROOKED CREEK RD
GREENVILLE NC
27858-8432
US

V. Phone/Fax

Practice location:
  • Phone: 252-737-7021
  • Fax: 252-737-7049
Mailing address:
  • Phone: 252-737-7021
  • Fax: 252-737-7049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number5136
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: