Provider Demographics
NPI:1124467766
Name:COLLINS, TRISTAN (DDS)
Entity type:Individual
Prefix:DR
First Name:TRISTAN
Middle Name:
Last Name:COLLINS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 W 104TH AVE
Mailing Address - Street 2:STE 201
Mailing Address - City:NORTHGLENN
Mailing Address - State:CO
Mailing Address - Zip Code:80234-4138
Mailing Address - Country:US
Mailing Address - Phone:303-427-6462
Mailing Address - Fax:
Practice Address - Street 1:421 W 104TH AVE
Practice Address - Street 2:SUITE #201
Practice Address - City:NORTHGLENN
Practice Address - State:CO
Practice Address - Zip Code:80234-4137
Practice Address - Country:US
Practice Address - Phone:303-427-6462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-17
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO002019971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice