NPIMap

Organization Active NPI

R. Charlie and Ute J Collins DDS, PLLC

  • General Practice Dentistry
  • Mount Vernon, WA
National Provider Identifier
1619199841
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
10103 Issued in WA
Legal business name
R. CHARLIE AND UTE J COLLINS DDS, PLLC
Practice address
1210 Roosevelt Ave
Mount Vernon, WA 98273-2425
Phone
(360) 424-5650
Fax
(360) 424-9672
NPI assigned
May 3, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Authorized official

Name
Ute J Collins, DDSNPI 1235192907
Title
Owner
Phone
(360) 424-5650

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 10103 WA Primary

Addresses

Primary practice location

1210 Roosevelt Ave
Mount Vernon, WA 98273-2425

Mailing address

1210 Roosevelt Ave
Mount Vernon, WA 98273-2425
Phone (360) 424-5650

Other identifiers 7

IdentifierTypeStateIssuer
10103OtherWAWA STATE LICENSE
5050042MedicaidWA
$$$$$$$$$OtherWASSN
1235192907OtherWAINDIVIDUAL NPI
1863209OtherWAUNITED CONCORDIA ID
5050471MedicaidWA
602 548 356OtherWAUBI

National Provider Directory

National Provider Directory
Tax ID family
R Charlie and Ute J Collins DDS PLLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1210 Roosevelt Ave
Mount Vernon, WA 98273
Phone (360) 424-5650

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1178150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1619199841",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1210 ROOSEVELT AVE",
            "city": "MOUNT VERNON",
            "state": "WA",
            "postal_code": "982732425",
            "telephone_number": "360-424-5650",
            "fax_number": "360-424-9672"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1210 ROOSEVELT AVE",
            "city": "MOUNT VERNON",
            "state": "WA",
            "postal_code": "982732425",
            "telephone_number": "360-424-5650",
            "fax_number": "360-424-9672"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "R. CHARLIE AND UTE J COLLINS DDS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-03",
        "last_updated": "2023-03-07",
        "status": "A",
        "authorized_official_last_name": "COLLINS",
        "authorized_official_first_name": "UTE",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "360-424-5650",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "10103",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WA STATE LICENSE",
            "identifier": "10103",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5050042",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SSN",
            "identifier": "$$$$$$$$$",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI",
            "identifier": "1235192907",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA ID",
            "identifier": "1863209",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5050471",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UBI",
            "identifier": "602 548 356",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Vernon, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.