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General NPI Number Information
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NPI Number | 1528154119
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Entity Type | Individual
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Provider Name | NATHAN CHARLES COLLINS D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 10/27/2016
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Provider Practice Location Address
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Address Line | 201 CHILDERS DR SUITE 117
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City | BASTROP
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State | TX
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Zip | 78602-4154
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Country | US
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Telephone | 512-800-1919
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Fax | 512-582-8520
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Provider Business Mailing Address
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Address Line | 13104 LIPTON LOOP 13104 LIPTON LOOP
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City | DEL VALLE
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State | TX
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Zip | 78617-3698
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Country | US
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Telephone | 512-800-1919
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Fax |
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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 | 1223D0001X
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Taxonomy Name | Public Health Dentistry
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License Number | 22349
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License Number State | TX
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