MEDICARE: DR. GEORGE G COLLINS III DMD

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	DN14039	FL

General Provider Information

NPI Number	:	1902906365
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEORGE G COLLINS III DMD

Provider Business Mailing Address
First Line	:	1575 INDIAN RIVER BLVD
Second Line	:	SUITE C-140
City	:	VERO BEACH
State	:	FL
Zip	:	32960-5639
Country	:	US
Telephone Number	:	772-770-3246
Fax Number	:	772-770-5972

Provider Business Practice Location Address
First Line	:	1575 INDIAN RIVER BLVD
Second Line	:	SUITE C-140
City	:	VERO BEACH
State	:	FL
Zip	:	32960-5639
Country	:	US
Telephone Number	:	772-770-3246
Fax Number	:	772-770-5972

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

Provider Enumeration Date	:	09/25/2006
Last Update Date	:	07/09/2007

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