MEDICARE: DR. ROBERT J COLLINS DMD, MPH

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	1223D0001X	Public Health Dentistry	DN13205	MA

General Provider Information

NPI Number	:	1225606171
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT J COLLINS DMD, MPH

Provider Business Mailing Address
First Line	:	8017 GATOR PALM DR
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33966-6446
Country	:	US
Telephone Number	:	239-313-6774
Fax Number	:

Provider Business Practice Location Address
First Line	:	240 S 40TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-6030
Country	:	US
Telephone Number	:	215-490-6171
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2021
Last Update Date	:	06/16/2021

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