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General NPI Number Information
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NPI Number | 1730436189
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Entity Type | Individual
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Provider Name | KYLE BRANDON COLLINS DMD
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Gender | Male
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Dates
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Enumeration Date | 08/03/2012
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Last Update Date | 03/28/2024
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Provider Practice Location Address
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Address Line | 301 E ASH ST
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City | CALDWELL
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State | ID
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Zip | 83605-5282
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Country | US
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Telephone | 208-454-1222
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Fax | 208-459-6947
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Provider Business Mailing Address
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Address Line | 301 E ASH ST
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City | CALDWELL
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State | ID
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Zip | 83605-5282
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Country | US
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Telephone | 208-454-1222
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Fax | 208-459-6947
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D-4440
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License Number State | ID
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