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General NPI Number Information
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NPI Number | 1497904080
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Entity Type | Organization
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Legal Business Name | JOHNSON & COLLINS ORTHODONTICS
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Dates
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Enumeration Date | 09/18/2008
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Last Update Date | 09/18/2008
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Provider Practice Location Address
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Address Line | 2121 CENTRAL DR STE 2
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City | BEDFORD
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State | TX
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Zip | 76021-5885
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Country | US
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Telephone | 817-283-3777
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Fax | 817-283-6929
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Provider Business Mailing Address
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Address Line | 2121 CENTRAL DR STE 2
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City | BEDFORD
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State | TX
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Zip | 76021-5885
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Country | US
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Telephone | 817-283-3777
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Fax | 817-283-6929
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Authorized Official
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Title or Position | OWNER
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Name | MR. MONTE KEITH COLLINS
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Credential | DDS, MSD
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Telephone | 817-283-3777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 14170
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License Number State | TX
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