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General NPI Number Information
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NPI Number | 1306868401
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Entity Type | Organization
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Legal Business Name | COLLINS FAMILY DENTISTRY
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Dates
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Enumeration Date | 07/25/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 2105 BROAD AVE STE E
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City | LANETT
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State | AL
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Zip | 36863-3117
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Country | US
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Telephone | 334-642-2200
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Fax |
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Provider Business Mailing Address
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Address Line | 2105 BROAD AVE STE E
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City | LANETT
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State | AL
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Zip | 36863
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Country | US
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Telephone | 334-642-2200
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. PAIGE J COLLINS
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Credential | D.M.D.
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Telephone | 334-642-2200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 4359
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 5480
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License Number State | AL
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 4617
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License Number State | AL
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Taxonomy #4
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 5836
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License Number State | AL
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