MEDICARE: RAYMOND F COLLINS DDS

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	122300000X	Dentist	DD2469	NM
2	1223G0001X	General Practice Dentistry	6443	NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5487	OTHER	NE	BCBS PROVIDER ID
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427032671
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAYMOND F COLLINS DDS

Provider Business Mailing Address
First Line	:	1000 BLUE HOLE RD
Second Line	:
City	:	SANTA ROSA
State	:	NM
Zip	:	88435-2533
Country	:	US
Telephone Number	:	505-718-6899
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 BLUE HOLE DRIVE
Second Line	:
City	:	SANTA ROSA
State	:	NM
Zip	:	88435-2533
Country	:	US
Telephone Number	:	505-718-6899
Fax Number	:

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

Provider Enumeration Date	:	12/01/2005
Last Update Date	:	09/11/2025

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