Mark Alan Collins, D.D.S
Individual provider Active NPI Dentist · Fort Mohave, AZ
NPI 1497920672 · NPPES record last updated Mar 27, 2012
Key facts
- NPI
- 1497920672
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- AZ4792 (AZ)
- Practice address
- 1501 E Camp Mohave Rd # 1
Fort Mohave, AZ 86426-9406 - Phone
- (928) 758-8887
- NPI assigned
- Apr 28, 2008
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AZ4792 | AZ | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | AZ4792 | AZ | Yes |
Addresses
Primary practice location
1501 E Camp Mohave Rd # 1
Fort Mohave, AZ 86426-9406
Mailing address
1501 E Camp Mohave Rd # 1
Fort Mohave, AZ 86426-9406
Phone (928) 758-8887
Other providers in Fort Mohave, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 27, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.