Active NPI
Jerry Lee Collins Jr.
- Dental Hygienist
- Flagstaff, AZ
National Provider Identifier
1760096085
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Hygienist
- Practice address
- 5205 E Cortland Blvd
Flagstaff, AZ 86004-9362 - Phone
- (520) 230-6360
- NPI assigned
- Sep 3, 2020
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Hygienist | 124Q00000X | Primary |
Addresses
Primary practice location
5205 E Cortland Blvd
Flagstaff, AZ 86004-9362
Mailing address
5205 E Cortland Blvd
Flagstaff, AZ 86004-9362
Phone (520) 230-6360
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1599091200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1599091200000",
"number": "1760096085",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5205 E CORTLAND BLVD",
"city": "FLAGSTAFF",
"state": "AZ",
"postal_code": "860049362",
"telephone_number": "520-230-6360"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5205 E CORTLAND BLVD",
"city": "FLAGSTAFF",
"state": "AZ",
"postal_code": "860049362",
"telephone_number": "520-230-6360"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COLLINS",
"first_name": "JERRY",
"middle_name": "LEE",
"name_suffix": "Jr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-09-03",
"last_updated": "2020-09-03",
"certification_date": "2020-09-03",
"status": "A"
},
"taxonomies": [
{
"code": "124Q00000X",
"taxonomy_group": "",
"desc": "Dental Hygienist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Flagstaff, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 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.