Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0221X | Pediatric Dentist | G5-OOOO552 | DE |
N | 1223X0400X | Orthodontists | G5-0000552 | DE |
NPI | 1083790844 |
---|---|
Provider Name | Ronald Edward Collins |
First Address | Newark, DE 19702-4727 |
Second Address | Newark, DE 19702-4727 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0000901908 | (05) | DE |