Provider Demographics
NPI:1962595918
Name:COLLINS, JOHN GREGGORY (DMD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:GREGGORY
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 1:3001 RALEIGH ROAD PKWY W # B
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27896-8213
Mailing Address - Country:US
Mailing Address - Phone:252-293-4469
Mailing Address - Fax:252-293-4479
Practice Address - Street 1:3001 RALEIGH ROAD PKWY W # B
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27896-8213
Practice Address - Country:US
Practice Address - Phone:252-293-4469
Practice Address - Fax:252-293-4479
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC61321223G0001X, 1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No1223G0001XDental ProvidersDentistGeneral Practice