Provider Demographics
NPI:1306868401
Name:COLLINS FAMILY DENTISTRY
Entity type:Organization
Organization Name:COLLINS FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PAIGE
Authorized Official - Middle Name:J
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:334-642-2200
Mailing Address - Street 1:2105 BROAD AVE
Mailing Address - Street 2:STE E
Mailing Address - City:LANETT
Mailing Address - State:AL
Mailing Address - Zip Code:36863
Mailing Address - Country:US
Mailing Address - Phone:334-642-2200
Mailing Address - Fax:
Practice Address - Street 1:2105 BROAD AVE
Practice Address - Street 2:STE E
Practice Address - City:LANETT
Practice Address - State:AL
Practice Address - Zip Code:36863-3117
Practice Address - Country:US
Practice Address - Phone:334-642-2200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4359122300000X
AL5480124Q00000X
AL46171223G0001X
AL5836124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered122300000XDental ProvidersDentistGroup - Single Specialty
Not Answered124Q00000XDental ProvidersDental HygienistGroup - Single Specialty
Not Answered1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
91622OtherBCBS PROVIDER NUMBER
860466OtherUNITED CONCORDIA PROVIDER
860466OtherUNITED CONCORDIA PROVIDER