Organization
R. CHARLIE AND UTE J COLLINS DDS, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
UTE J COLLINS DDS (OWNER)
(360) 424-5650
Entity
Organization
Contact information
Practice address
1210 ROOSEVELT AVE, MOUNT VERNON, WA 98273-2425
(360) 424-5650
(360) 424-9672
Mailing address
1210 ROOSEVELT AVE, MOUNT VERNON, WA 98273-2425
(360) 424-5650
(360) 424-9672
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
10103
WA
Other
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
Enumeration date
05/03/2007
Last updated
03/07/2023
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