Provider Demographics
NPI:1215903554
Name:COLLINS, CHAD P (DMD)
Entity type:Individual
Prefix:
First Name:CHAD
Middle Name:P
Last Name:COLLINS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 W 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2504
Mailing Address - Country:US
Mailing Address - Phone:509-624-2202
Mailing Address - Fax:509-624-9378
Practice Address - Street 1:322 W 7TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2504
Practice Address - Country:US
Practice Address - Phone:509-624-2202
Practice Address - Fax:509-624-9378
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA87101223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5034178Medicaid
WAV01068Medicare UPIN
WA8806529Medicare ID - Type Unspecified