# R. CHARLIE AND UTE J COLLINS DDS, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1619199841
- **Authorized official:** UTE J COLLINS DDS (OWNER)
- **Authorized official phone:** (360) 424-5650

## Contact information

- **Practice address:** 1210 ROOSEVELT AVE, MOUNT VERNON, WA 98273-2425
- **Practice address phone:** (360) 424-5650
- **Practice address fax:** (360) 424-9672
- **Mailing address:** 1210 ROOSEVELT AVE, MOUNT VERNON, WA 98273-2425
- **Mailing address phone:** (360) 424-5650
- **Mailing address fax:** (360) 424-9672

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 10103 | WA | Yes |

## Other

- **Enumeration date:** 05/03/2007
- **Last updated:** 03/07/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | $$$$$$$$$ | SSN | WA |
| 01 | — | 10103 | WA STATE LICENSE | WA |
| 01 | — | 1235192907 | INDIVIDUAL NPI | WA |
| 01 | — | 1863209 | UNITED CONCORDIA ID | WA |
| 05 | — | 5050042 | — | WA |
| 05 | — | 5050471 | — | WA |
| 01 | — | 602 548 356 | UBI | WA |