NPIMap

Organization Active NPI

Collins Dental

  • General Practice Dentistry
  • Santa Rosa, NM
National Provider Identifier
1740484641
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DD2469 Issued in NM
Legal business name
COLLINS DENTAL
Practice address
1000 Blue Hole Rd
Santa Rosa, NM 88435-2533
Phone
(505) 718-6899
NPI assigned
Jun 13, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Raymond Frank Collins, DDSNPI 1427032671
Title
President
Phone
(505) 718-6899

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X DD2469 NM Primary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X DD2208 NM

Addresses

Primary practice location

1000 Blue Hole Rd
Santa Rosa, NM 88435-2533

Mailing address

1000 Blue Hole Rd
Santa Rosa, NM 88435-2533
Phone (505) 718-6899

Other names 1

  • Deep Blue Dental Doing business as

National Provider Directory

National Provider Directory

Locations

1000 Blue Hole Rd
Santa Rosa, NM 88435
Phone (505) 718-6899

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": "1181692800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1740484641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 BLUE HOLE RD",
            "city": "SANTA ROSA",
            "state": "NM",
            "postal_code": "884352533",
            "telephone_number": "505-718-6899"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 BLUE HOLE RD",
            "city": "SANTA ROSA",
            "state": "NM",
            "postal_code": "884352533",
            "telephone_number": "505-718-6899"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLLINS DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-13",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "COLLINS",
        "authorized_official_first_name": "RAYMOND",
        "authorized_official_middle_name": "FRANK",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "505-718-6899",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "NM",
            "license": "DD2469",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "NM",
            "license": "DD2208",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Deep Blue Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Santa Rosa, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.