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General NPI Number Information
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NPI Number | 1710300595
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Entity Type | Organization
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Legal Business Name | R. CHARLIE COLLINS AND UTE J. COLLINS
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Dates
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Enumeration Date | 01/29/2014
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Last Update Date | 01/29/2014
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Provider Practice Location Address
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Address Line | 1220 22ND ST SUITE C
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City | ANACORTES
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State | WA
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Zip | 98221-2582
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Country | US
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Telephone | 360-293-5311
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Fax | 360-293-5114
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Provider Business Mailing Address
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Address Line | 1220 22ND ST SUITE C
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City | ANACORTES
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State | WA
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Zip | 98221-2582
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Country | US
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Telephone | 360-293-5311
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Fax | 360-293-5114
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Authorized Official
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Title or Position | CO-OWNER
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Name | DR. RYAN CHARLIE COLLINS
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Credential | D.D.S.
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Telephone | 360-293-5311
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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 | DE00010086
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License Number State | WA
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