# COLLINS DENTAL

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Deep Blue Dental
- **Organization subpart:** No

## Provider details

- **NPI number:** 1740484641
- **Authorized official:** DR. RAYMOND FRANK COLLINS DDS (PRESIDENT)
- **Authorized official phone:** (505) 718-6899

## Contact information

- **Practice address:** 1000 BLUE HOLE RD, SANTA ROSA, NM 88435-2533
- **Practice address phone:** (505) 718-6899
- **Mailing address:** 1000 BLUE HOLE RD, SANTA ROSA, NM 88435-2533
- **Mailing address phone:** (505) 718-6899

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | DD2208 | NM | — |
| 1223G0001X | General Practice Dentistry | DD2469 | NM | Yes |

## Other

- **Enumeration date:** 06/13/2007
- **Last updated:** 08/22/2020