1528154119 NPI number — DR. NATHAN CHARLES COLLINS D.D.S.

Table of content: DR. NATHAN CHARLES COLLINS D.D.S. (NPI 1528154119)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528154119 NPI number — DR. NATHAN CHARLES COLLINS D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COLLINS
Provider First Name:
NATHAN
Provider Middle Name:
CHARLES
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.D.S.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528154119
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/27/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13104 LIPTON LOOP
Provider Second Line Business Mailing Address:
13104 LIPTON LOOP
Provider Business Mailing Address City Name:
DEL VALLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78617-3698
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-800-1919
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 CHILDERS DR
Provider Second Line Business Practice Location Address:
SUITE 117
Provider Business Practice Location Address City Name:
BASTROP
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78602-4154
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-800-1919
Provider Business Practice Location Address Fax Number:
512-582-8520
Provider Enumeration Date:
10/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223D0001X , with the licence number:  22349 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7127065 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




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