Basic Information
| Provider Information | |||||||||
| NPI: | 1003018383 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COLLINS | ||||||||
| FirstName: | RODNEY | ||||||||
| MiddleName: | MICHAEL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 407 BROOKSIDE AVENUE | ||||||||
| Address2: | |||||||||
| City: | REDLANDS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92373 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9093353644 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 407 BROOKSIDE AVE | ||||||||
| Address2: | |||||||||
| City: | REDLANDS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923734609 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9093353644 | ||||||||
| FaxNumber: | 9093353641 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 31907 | CA | Y | Dental Providers | Dentist | General Practice |
No ID Information.