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General NPI Number Information
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NPI Number | 1700491545
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Entity Type | Organization
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Legal Business Name | COLLINS ORTHODONTICS, PA
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Dates
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Enumeration Date | 09/09/2020
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Last Update Date | 03/23/2021
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Provider Practice Location Address
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Address Line | 2946 JEREMIAH LN NW
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City | ROCHESTER
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State | MN
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Zip | 55901-4445
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Country | US
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Telephone | 507-258-5400
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Fax |
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Provider Business Mailing Address
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Address Line | 2946 JEREMIAH LN NW
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City | ROCHESTER
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State | MN
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Zip | 55901-4445
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Country | US
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Telephone | 507-258-5400
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Fax |
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Authorized Official
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Title or Position | ORTHODONTIST, OWNER
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Name | DR. GRANT CONRAD COLLINS
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Credential | DDS, MS
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Telephone | 507-258-5400
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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 |
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License Number State |
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