Provider Demographics
NPI:1528154119
Name:COLLINS, NATHAN CHARLES (DDS)
Entity type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:CHARLES
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 1:13104 LIPTON LOOP
Mailing Address - Street 2:13104 LIPTON LOOP
Mailing Address - City:DEL VALLE
Mailing Address - State:TX
Mailing Address - Zip Code:78617-3698
Mailing Address - Country:US
Mailing Address - Phone:512-800-1919
Mailing Address - Fax:
Practice Address - Street 1:201 CHILDERS DR
Practice Address - Street 2:SUITE 117
Practice Address - City:BASTROP
Practice Address - State:TX
Practice Address - Zip Code:78602-4154
Practice Address - Country:US
Practice Address - Phone:512-800-1919
Practice Address - Fax:512-582-8520
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX223491223D0001X, 1223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM7127065Medicaid