MEDICARE: SUSAN M COLLINS DMD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	2854	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013184548
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUSAN M COLLINS DMD PA

Provider Business Mailing Address
First Line	:	1251 EBENEZER RD
Second Line	:
City	:	ROCK HILL
State	:	SC
Zip	:	29732-2353
Country	:	US
Telephone Number	:	803-324-3277
Fax Number	:	803-324-2264

Provider Business Practice Location Address
First Line	:	1251 EBENEZER RD
Second Line	:
City	:	ROCK HILL
State	:	SC
Zip	:	29732-2353
Country	:	US
Telephone Number	:	803-324-3277
Fax Number	:	803-324-2264

Authorized Official
Title or Position	:	OWNER
Name	:	DR. SUSAN M COLLINS
Credential	:	DMD
Telephone Number	:	803-324-3277

Provider Enumeration Date	:	05/14/2008
Last Update Date	:	05/14/2008

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