Healthcare Provider Details

I. General information

NPI: 1235192907
Provider Name (Legal Business Name): UTE J. COLLINS D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 ROOSEVELT AVE.
MT. VERNON WA
98273
US

IV. Provider business mailing address

17361 OLYMPIC PL
MOUNT VERNON WA
98274-7771
US

V. Phone/Fax

Practice location:
  • Phone: 360-424-5650
  • Fax:
Mailing address:
  • Phone: 360-848-1589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number10103
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: