Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 22349 | TX |
NPI | 1528154119 |
---|---|
Provider Name | Dr. Nathan Charles Collins |
First Address | Del Valle, TX 78617-3698 |
Second Address | Bastrop, TX 78602-4154 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 27/10/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7127065 | (05) | NM |