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General NPI Number Information
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NPI Number | 1134117252
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Entity Type | Individual
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Provider Name | BOBBY MCMANUS COLLINS II DDS, MS
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Gender | Male
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Dates
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Enumeration Date | 10/12/2005
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Last Update Date | 12/10/2012
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Provider Practice Location Address
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Address Line | 1851 MACGREGOR DOWNS RD EAST CAROLINA UNIVERSITY SCHOOL OF DENTAL MEDICINE
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City | GREENVILLE
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State | NC
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Zip | 27834-5925
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Country | US
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Telephone | 252-737-7021
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Fax | 252-737-7049
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Provider Business Mailing Address
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Address Line | 2008 CROOKED CREEK RD
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City | GREENVILLE
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State | NC
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Zip | 27858-8432
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Country | US
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Telephone | 252-737-7021
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Fax | 252-737-7049
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0106X
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Taxonomy Name | Oral and Maxillofacial Pathology Dentistry
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License Number | 5136
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License Number State | NC
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