Provider Demographics
NPI:1386731230
Name:COLLINS, GARY R (MSD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:R
Last Name:COLLINS
Suffix:
Gender:M
Credentials:MSD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:5500 SKYLINE DRIVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808
Mailing Address - Country:US
Mailing Address - Phone:410-398-8642
Mailing Address - Fax:
Practice Address - Street 1:5500 SKYLINE DRIVE
Practice Address - Street 2:SUITE 1
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808
Practice Address - Country:US
Practice Address - Phone:302-235-3531
Practice Address - Fax:302-239-5352
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE7831223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics