Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | DN13205 | MA |
NPI | 1225606171 |
---|---|
Provider Name | Dr. Robert J Collins |
First Address | Fort Myers, FL 33966-6446 |
Second Address | Philadelphia, PA 19104-6030 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2021 |
Last Update Date | 16/06/2021 |