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General NPI Number Information
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NPI Number | 1720649668
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Entity Type | Individual
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Provider Name | MATTHEW STEVEN COLLINS DMD
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Gender | Male
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Dates
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Enumeration Date | 06/21/2019
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Last Update Date | 07/22/2019
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Provider Practice Location Address
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Address Line | 1055 VALLEY RIVER WAY
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City | EUGENE
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State | OR
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Zip | 97401-2159
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Country | US
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Telephone | 541-255-2205
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Fax |
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Provider Business Mailing Address
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Address Line | 1759 VIA PAJARO
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City | CAMARILLO
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State | CA
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Zip | 93012-4086
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Country | US
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Telephone | 805-415-0345
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | D11074
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License Number State | OR
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