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General NPI Number Information
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NPI Number | 1578885471
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Entity Type | Organization
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Legal Business Name | DR. SEAN M. COLLINS
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Dates
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Enumeration Date | 02/18/2010
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Last Update Date | 02/18/2010
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Provider Practice Location Address
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Address Line | 630 S FAIRMONT AVE STE B
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City | LODI
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State | CA
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Zip | 95240-3803
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Country | US
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Telephone | 209-367-3595
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Fax | 209-367-9276
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Provider Business Mailing Address
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Address Line | 630 S FAIRMONT AVE STE B
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City | LODI
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State | CA
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Zip | 95240-3803
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Country | US
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Telephone | 209-367-3595
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Fax | 209-367-9276
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Authorized Official
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Title or Position | OWNER
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Name | DR. SEAN COLLINS
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Credential | D.D.S., M.S.D
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Telephone | 209-367-3595
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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 | 36740
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License Number State | CA
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