Samuel Deon Collins, DDS

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

28595 Issued in TX

Practice address

19404 Morris Ave
Manvel, TX 77578

Phone

(404) 370-2510

NPI assigned

Jun 15, 2006

Last updated

Jun 6, 2023By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Manvel Aesthetic Dentistry LLC

  • General Practice Dentistry
  • Manvel, TX
  • NPI 1376009704
  NPD Authorized official
• Rosenberg Dental and Implant Center

  dba Samuel D Collins MBR

  • Oral and Maxillofacial Surgery Clinic/Center
  • Rosenberg, TX
  • NPI 1710672209
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150329600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686009600000",
    "number": "1447294996",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19404 MORRIS AVE",
            "city": "MANVEL",
            "state": "TX",
            "postal_code": "775783702",
            "telephone_number": "404-370-2510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19404 MORRIS AVE",
            "city": "MANVEL",
            "state": "TX",
            "postal_code": "77578",
            "telephone_number": "404-370-2510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COLLINS",
        "first_name": "SAMUEL",
        "middle_name": "DEON",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-15",
        "last_updated": "2023-06-06",
        "certification_date": "2023-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "TX",
            "license": "28595",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TX",
            "license": "28595",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MCNA",
            "identifier": "5620",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alan Chan
• Francis Joseph Charles Jr., R.N.
• Makayla Cleveland
• CN Dental Services, PLLC
• Scott M Codon, LPC
• Estela Rojas Cordova
• Cornerstone Care & Support Services, LLC
• Cornerstone Care Consumer Directed Services LLC
• Rachael Shannel Costly
• Craig J Crawford

• Oral and Maxillofacial Surgery (Dentist) in Manvel, TX
• Providers in Manvel, TX by specialty
• Oral and Maxillofacial Surgery (Dentist) in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.