Organization
COLLINS DENTAL
Active
Other names
Deep Blue Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RAYMOND FRANK COLLINS DDS (PRESIDENT)
(505) 718-6899
Entity
Organization
Contact information
Practice address
1000 BLUE HOLE RD, SANTA ROSA, NM 88435-2533
(505) 718-6899
Mailing address
1000 BLUE HOLE RD, SANTA ROSA, NM 88435-2533
(505) 718-6899
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
DD2208
NM
1223G0001X
General Practice Dentistry
Primary
DD2469
NM
Other
Enumeration date
06/13/2007
Last updated
08/22/2020
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